Elasticity imaging is a relatively new ultrasound-based technique for investigating musculoskeletal injury. Sonoelastography (SEL), the most commonly used technique, allows determination of the elastic properties of tissue by applying pressure. Purpose: To critically evaluate the literature regarding the use of SEL in the diagnosis of tendon and muscle alterations. Materials and Methods: This review includes a systematic literature search performed on major electronic databases. Eight articles were included. The GRADE approach was used to evaluate the quality of evidence presented in the included articles and the strength of their recommendations. Results: The results on human tendon disorders showed that the SEL findings correlated extremely well with conventional ultrasound (US) findings as well as with magnetic resonance imaging (MRI) and clinical examination. In some articles SEL was found to be even more sensitive than conventional ultrasound and in addition capable of identifying subclinical alterations that conventional ultrasound could not. For skeletal muscle, a close correlation between SEL and US and MRI was found, although there is only one article on the topic. SEL was found to be able to distinguish between healthy and diseased muscles and was potentially more sensitive in identifying early dystrophic changes than US or MRI. Conclusion: Based on this critical evaluation of the literature, SEL seems to be at least as feasible as US and MRI for assessing tendon alterations and able to identify subclinical tendon alterations not visible with conventional US. The findings in the reviewed articles suggest that SEL could become a supplementary imaging technique in the assessment of musculoskeletal alterations, potentially superior to US and MRI. Until more studies are available, SEL has to be viewed as an experimental examination without sufficient supporting evidence to be used as a routine examination equivalent to US and MRI.