Musculoskeletal Ultrasound Examination (MSK) for Physicians

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The MSK Examination window is now closed and will reopen July 23, 2024. 

The MSK ultrasound/sonography examination tests knowledge and skills required in making a reliable diagnosis and performing invasive procedures in musculoskeletal-related conditions. It’s required to pass the MSK exam in order to obtain the Registered in Musculoskeletal (RMSK) sonography certification.

By earning the Registered in Musculoskeletal (RMSK) sonography certification, physicians and advanced care providers gain a critical edge in promoting themselves as preeminent musculoskeletal practitioners.

Sonographers; Please note that there is a sonographer-specific musculoskeletal credential offered by APCA’s companion organization, ARDMS. Click here for details.

MSK Examination Application Dates MSK Examination Administration Dates
January 23, 2024 – April 2, 2024* April 16, 2024 – May 16, 2024
July 23, 2024 – October 1, 2024* October 15, 2024 – November 14, 2024

*NOTE: Application window closes at midnight EST.

Taking the MSK Ultrasound Exam: Everything You Need to Know 

The MSK examination assesses the knowledge, skills and abilities in the areas of muscles, joints, tendons ligaments and soft tissues of the body.

As a windowed examination, scores for the MSK examination will be available on MY APCA approximately 60 days after the close of the administration. For more information, review the “Scoring” tab.

Periodically, APCA conducts a MSK Practice Analysis and updates the MSK examination to reflect the frequency and importance of MSK tasks being performed by physicians.

View the 2014 MSK Practice Analysis Results​​​.

All questions on the Musculoskeletal Sonography (MSK) examination will fall under the domains and subdomains listed in the MSK content outline. It is essential that you review the MSK content outline to understand what will be covered in the examination.

The MSK examination is four hours and contains ~200 multiple-choice questions. In order to earn the RMSK certification, the MSK examination must be taken and passed.

Note: The MSK examination is only offered during select periods of the year. Refer to the “Schedule” tab for upcoming dates.​

APCA functions under policies intended to demonstrate impartiality, high ethical standards and validity of its certification assessments.

APCA does not restrict Applicants, Candidates or those becoming a Certificant based on limiting conditions, such as membership of an association or professional society of any organization. APCA will not unfairly impede or inhibit access to its certification to Applicants, Candidates or Certificants who meet our stated policies regarding qualification requirements, renewal requirements and/or passing APCA’s psychometrically sound certification assessments.  ​​​

To apply for the MSK examination and earn the RMSK certification, you must meet the eligibility requirements of the MSK Prerequisite.​

APCA offers one prerequisite under which to apply for the MSK examination. All applicants, including existing APCA Certificants, must meet all requirements of the MSK prerequisite to apply.


Must hold and be practicing as one of the following designations with a valid medical license in good standing without any conditions or restrictions to practice medicine: Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), Doctor of Podiatric Medicine (DPM), Bachelor of Medicine, Bachelor of Surgery (MBBS), Doctor of Chiropractic (DC)*, Nurse Practitioner (NP)*, Physician Assistant (PA)*, Doctor of Physical Therapy (DPT)*, Physiotherapist \ Physical Therapist (PT)*

Required Clinical Musculoskeletal Ultrasound Experience

Performed and/or authorized diagnosis of a minimum of 150 musculoskeletal ultrasound studies within the preceding 36 months of application. No more than 5% (8 cases) of the 150-case log requirement can be labeled as therapeutic (injection or aspiration). For purposes of satisfying this requirement, these studies must be completed on actual patients in a clinical diagnostic** setting. Simulation is not acceptable for this attestation.

Recommended Continuing Medical Education (CME)

Although CMEs are not required to apply for the MSK examination, APCA highly recommends and encourages Musculoskeletal (MSK) sonography Prerequisite Note: All listed items must be met and completed prior to submission. applicants to earn a minimum of 30 CMEs in musculoskeletal ultrasound to assist applicants in preparing to take the MSK examination. Applicants do not need to submit CME documentation as this is only a recommendation and not a requirement.

Click to view the MSK Prerequisites.​

You will be considered a Re-applicant for the MSK examination if you have previously been approved to sit for it.

To sit for the MSK examination as a Re-applicant, submit the application and payment. Your application will automatically be approved and you will be able to schedule within a day.

You must wait until the next administration to retake the MSK examination if you do not pass it.​

The MSK examination is a windowed examination. Therefore, it is only offered during select periods of the year.

MSK Examination Application Dates MSK Examination Administration Dates
January 23, 2024 – April 2, 2024* April 16, 2024 – May 16, 2024
July 23, 2024 – October 1, 2024* October 15, 2024 – November 14, 2024

To apply, please follow these steps:

  • Log in to MY APCA and choose the “Apply Online” option. Choose the MSK examination.
  • Complete the online application form, upload documents, and submit payment.
  • Application review process can take up to 5 business days.
  • Once we have reviewed your documentation, we will email you either an Examination Confirmation Letter (ECL) or a request for additional documentation.

The application checklist is a helpful, online tool that lets you track the status of your submitted application. To view it, log into MY APCA and visit the “Application Checklist” from the “Application Center” drop down menu. There, you can find out what documentation we have accepted and what additional documentation we may still need. If the checklist is not available, it simply means we have not yet reviewed your documentation.​

When you receive the ECL, you may contact Pearson VUE to schedule an examination appointment during your eligibility period. The eligibility period will be listed on your ECL or check above to view the current MSK examination administration dates. If you are found ineligible to take the examination, your application will be partially refunded (less the $100 USD processing fee per examination).

If you do not upload the documents at the time of application submission, you may upload them to your MY APCA account by clicking the “My Resources” tab, then “Upload Documents”. For “File Type” select “Application Documents”.

For more details, please visit the MSK How to Apply Guide​.

View our steps to apply video to learn more about the application process:

The necessary supporting documentation for the MSK examination must be received at the time of your online application submission. You will be asked to complete a third-party attestation form during the online application process.

  • Medical License: Copy of a valid medical license in good standing without any conditions or restrictions to practice as an MD, DO, DPM, MBBS, DC, NP, PA, DPT or PT.
  • Attestation Letter: Completed third-party attestation form indicating the performance and/or authorized diagnosis of a minimum of 150 musculoskeletal ultrasound studies within the preceding 36 months of application. To download the form, go to

Note: We do not retain application documentation received prior to receipt and payment of the online application. Any documentation received prior to the completed online application will be discarded.

The MSK examination fee is $660, which includes a $100 USD non-refundable processing fee.  If you take an APCA examination at an international test center (outside the U.S., Canada and Mexico), you will be charged an additional non-refundable $50 USD fee when you schedule your examination. This fee is subject to change without notice.​

If you need special accommodations, please select “Yes” for “Special Accommodations” in the application and submit the following along with your completed application:

  • An original copy of a letter dated within the past five years and typed on official letterhead from a qualified physician or health care provider who specializes in the disability. This letter must document the disability and its severity, describe the applicant’s limitation due to the disability and state exactly what accommodations are recommended. The letter must contain an original signature and the physician’s or provider’s credentials.
  • An original copy of a comprehensive medical evaluation/report of the diagnosed disability from the physician or health care provider, dated within the past five years.
  • A completed Americans with Disabilities Act (ADA) Special Accommodations Questionnaire​​, which must be submitted each time you apply for an examination.

For more information, visit Americans with Disabilities Act​.​

Once your MSK application has been approved, an Examination Confirmation Letter (ECL) will be emailed to you to schedule an examination with Pearson VUE – APCA’s official testing vendor. The ECL will include your eligibility period based on the set administration dates and you are encouraged to schedule promptly to ensure availability.

If you have not done so already, visit Pearson VUE​ to:

• Create a Pearson VUE account
• Search for seat availability
• Locate a test center
• Schedule an examination
• Contact Pearson VUE Customer Service

If you are taking the examination at an international test center (outside the U.S., Canada and Mexico), a $50 USD non-refundable fee and Value Added Tax (VAT) will be charged by Pearson VUE. All international scheduling fees and associated VAT will be charged at the time the examination is scheduled. The fees and associated VAT are subject to change without notice, and they are non-refundable.

To reschedule the date and time of your examination during your eligibility period, you must contact Pearson VUE​ (1-877-258-9220) at least 96 hours prior to the scheduled examination date and time.

Please note: This is a windowed examination and extensions are not available.  You can reschedule your appointment for another time within your stated eligibility period.  However, if you cannot take it within your stated eligibility period, please follow the cancellation procedure.

To cancel an examination appointment, you must contact Pearson VUE (1-877-258-9220) and cancel the scheduled appointment no later than 96 hours prior to the scheduled examination appointment time. You will receive a cancellation email from Pearson VUE.

To request a partial refund, you must wait 24 hours after canceling the appointment with Pearson VUE and then submit a cancellation/partial refund request no later than 96 hours prior to the last date of the eligibility period.

To submit this request:

  • Log in to your MY APCA​ account.
  • Visit “My Examination/Application Status” under “Application Center.”
  • Select the examination you wish to request a partial refund for. ​
  • Complete and submit the form.

We will refund your examination fee, less the $100 USD processing fee per examination, unless we receive your request too late, you never schedule your examination or you do not keep your scheduled examination appointment. Then, the entire examination and processing fees are forfeited.

Please note: This is a windowed examination and extensions are not available. You can reschedule your appointment for another time within your stated eligibility period. However, if you cannot take it within your stated eligibility period, please follow the cancellation procedure.

When you arrive at a test center, be prepared to:

  • Check in with a Test Center Administrator
  • Present one valid photo identification (ID); see Test Center Identification Requirements​
  • Provide a digital signature
  • Have your palm vein scanned
  • Take a test-day photograph

Note: The only thing that you can bring into the testing room is you. The test centers have lockers you can use to store personal belongings. Study materials as well as food and drink are prohibited in the test center. No visitors, guests, pets or children are allowed.

Important: Review APCA’s Examination Admission Compliance​ policies to ensure you are not refused admission at the test center and do not conduct unauthorized examination behavior.

Test centers will provide white boards for notes during the examination upon request.

If you need special accommodations, please select “Yes” for “Special Accommodations” in the application when you apply.

Taking a practice test is a great way to prepare for your actual examination. We offer an MSK Practice Test that simulates the computer interface used in the actual test center environment. The MSK practice test review is comprised of 30 sample questions and is 30 minutes long.

After you complete a practice test, you will be emailed a report that shows the number of questions you answered correctly. While the report is an indication of your knowledge, the practice tests results should not be used to predict how well you will perform on the actual test at the test center.

See FAQs​ for additional information.​

Each practice test costs $45 USD.

You can now register for a MSK practice test by signing into your MY APCA​ account and clicking the Sign Up/View Practice Test option in the Application Center tab. You can also view the computer system requirements in your MY APCA portal. For any general questions or technical problems regarding the practice tests, please call APCA at (800) 943-1709  or email

Before your session begins, you should review the test tutorial. Please note you will not get a chance to review the test tutorial during the actual practice test, so please prepare accordingly. Once your session begins, you have 30 minutes to complete the practice test.

Register​ for an MSK practice test, by signing in to your MY APCA account.

The MSK examination covers the following content areas. All percentages are an approximate distribution of the questions across the content areas.

MSK Content Outline​ ​(Please click on “MSK Content Outline” for the detailed Content Outline in PDF-Printable format).

General Sonographic Anatomy [26%]
General Sonographic Pathology [23%]
Ultrasound-guided Interventional Procedures [18%]
Integration of data [7%]
Physics and Instrumentation [26%]

Please note: All percentages are approximate.

Your score report will display and include performance feedback for these content areas.

After all of your diligent preparation and hours spent studying, here are a few valuable tips to help make your examination day a success:

  • Double check that you know where the test center is before examination day and give yourself plenty of time to get there. Remember, you MUST arrive and register at least 30 minutes before the examination begins.
  • Get a good night’s sleep before you take your examination. Being well rested and relaxed when you take your examination will help you concentrate.
  • Bring one form of current and valid identification that complies with the test center identification requirements​​.
  • Travel light. The only thing you can bring into the testing room is you. You can store your personal belongings — your car keys, watch, smartphone, purse, backpack, etc. — in lockers at the test center. The following items are not allowed in test centers: study materials, food, drink, visitors/guests, pets and children.
  • Request a white board if you plan to jot down notes during the examination. Test centers are using white boards (rather than paper) in an effort to “go green.”
  • Be advised that the use of a calculator for this examination is prohibited.  However, you may utilize the White Board provided at the test center or the digital White Board provided for online proctoring examinations for manual calculations.

Good luck!​

Even though we offer practice examinations and sample questions, we do not offer study materials for our examinations – but our sister organizations do. You can find materials at:

The MSK examination features Advanced Item Types (AIT) questions​​, which assess and measure your practical sonography skills. They include hotspot questions in which you will receive questions about individual images. You will use the cursor to mark the correct answer directly on the image.

Watch the video presented by APCA’s companion organization for sonographers, ARDMS: How to Answer a Hotspot Question.​

The MSK examination evaluates the knowledge and skills you must demonstrate. The primary test result is a PASS or FAIL decision. In addition, you will receive a scaled score, ranging from 300 to 700. A scaled score of 555 is required to pass all APCA examinations.

The scaled score is not a percentage of correct answers, nor is it built on a “curve” where a certain percentage of scores would pass and a certain percentage would fail. To learn more, visit Notification of Results and Scoring​​.​

Examination results and a full score report will be available approximately 60 days after the close of the examination administration. At that time, an email will be sent to you with instructions on how to access your score report in MY​ APCA​.

Candidates receiving a confirmed passing score on all required examinations and meeting all other requirements will be awarded a certification. For information on the APCA’s scoring methods, visit Notification of Results and Scoring​​.

Candidates who do not pass are invited to re-apply.

You can request a score verification for a $35 USD fee, payable by check, money order or credit card. Score verification ensures that the computer counted the correct and incorrect answers appropriately, but it does not review the questions and answers.

You must submit the completed Exam Score Verification Form​ within 30 days of having taken the examination in question. The Exam Score Verification Form will be returned if incomplete, unsigned or unpaid.

When deciding whether to have your score verified, please consider that APCA examinations are scored electronically with a high degree of accuracy, and it is unlikely that verification will alter your original score.

Below are the pass rates for the MSK examination. From 2012 – 2014, the MSK examination was offered to both physicians and sonographer-level medical professionals. In 2015, the MSK examination was moved to a physician-level examination.

First-time takers: 75%
Overall: 73%

First-time takers: 67%
Overall: 64%​

First-time takers: 70%
Overall: 67%​

First-time takers: 61%
Overall: 59%​

First-time takers: 62%
Overall: 58%​

First-time takers: 57%
Overall: 50%​

First-time takers: 58%
Overall: 60​%

First-time takers: 66%
Overall: 63%

First-time takers: 93%
Overall: 93%

First-time takers: 92%
Overall: 90%​

First-time takers: 97%
Overall: 97%

Why take the MSK Exam & Get Your RMSK Certification?

On the fence about taking the MSK sonography exam to get your RMSK certification? Practitioners who have already earned their RMSK certification say that it:

  • Demonstrates their advanced skills and knowledge in MSK
  • Improves both patient safety and care
  • Offers opportunity for career advancement
  • Provides for insurance reimbursements