In recent years, the incidence of tuberculosis (TB) has increased, primarily in developing countries, but also in Europe and North America. The association between TB and human immunodeficiency virus infection is well-documented. In these cases, TB is more likely to be extrapulmonary. The spine is the most common site for skeletal TB. Atypical appearances may be present in immigrants. Plain radiography remains the cornerstone for imaging, but newer cross-sectional modalities such as computed tomography, ultrasonography, and magnetic resonance imaging are becoming increasingly valuable in early and accurate diagnosis. This article reviews the features of musculoskeletal TB and the role that imaging plays in diagnosis and management.