There has been a significant increase in use of ultrasound in the assessment of sports injury worldwide. Awareness of the value of high-resolution musculoskeletal ultrasound has lead to increasing interest by both radiologists and clinicians in using ultrasound to perform guided interventions in sports injury patients. This chapter discusses the principles of ultrasound-guided intervention including both the technical aspects of performing a procedure and the important clinical decision-making processes. There are a wide range of interventions available including diagnostic injections to determine the origin of symptoms or therapeutic interventions targeted on a variety of tissues are reviewed.