Tuberculosis (TB) is a leading cause of infection worldwide, with extrapulmonary TB affecting approximately 10–20% of patients, of which 10–15% involves the musculoskeletal system. Appendicular musculoskeletal TB manifests as osteomyelitis, septic arthritis, and soft tissue infections such as tenosynovitis, bursitis, and pyomyositis, causing serious complications and impaired limb function. Selective application of suitable imaging modalities is crucial for guiding appropriate laboratory testing and early disease detection. Certain imaging features such as gradual osteoarticular destruction, intra-articular debris, large abscesses but minimal surrounding inflammation, soft tissue calcification, and sinus formation raise the possibility of tuberculous infection. However, many imaging findings are nonspecific, and certain differential diagnoses should be considered. The knowledge of pathophysiology and clinical manifestations, along with recognizing common imaging features of TB, can help establish the correct diagnosis and proper management.