This article illustrates how ultrasound (US) can be useful in the evaluation of painful hips. For an experienced examiner using high quality equipment, US is the imaging test of choice for tendon abnormalities, hernias, bursitis, and dynamic abnormalities such as extra-articular snapping hip. Ultrasound is also useful in screening for hip effusions and guiding diagnostic and therapeutic interventions. Ultrasound has a complementary role to magnetic resonance imaging (MRI) for labral pathology, although MRI or MR arthrography is preferable for most intra-articular pathologies. It is better tolerated, less expensive, and more readily available than MRI, and as US technology continues to improve, its role in hip imaging should grow.