Musculoskeletal disorders (MSDs) represent a significant global burden, necessitating precise diagnostic frameworks to prevent long-term disability. This review evaluates the clinical efficacy and comparative utility of the four primary imaging modalities: Conventional Radiography (X-ray), Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Musculoskeletal Ultrasound (MSK-US). While X-ray remains the essential frontline tool for skeletal alignment and fractures, CT provides superior three-dimensional visualization for complex trauma and preoperative planning. MRI stands as the gold standard for soft tissue, marrow, and ligamentous assessment due to its high contrast resolution, whereas Ultrasound offers unique real-time dynamic evaluation and interventional guidance. By synthesizing current diagnostic accuracies—ranging from CT’s precision in cortical detail to MRI’s sensitivity in early infection detection—this article establishes a multi-modal decision-making hierarchy. Furthermore, the review explores emerging paradigms, including Artificial Intelligence (AI) for automated diagnostics and molecular imaging for early biochemical detection. We conclude that a strategic, integrated approach utilizing both traditional and emerging technologies is vital for optimizing patient outcomes in modern musculoskeletal care.