NMR imaging has become an important diagnostic tool in the evaluation of musculoskeletal disease. However, its ability to evaluate pathogenic mechanisms of disease may eventually have even a greater impact on patient care. NMR imaging has significantly affected our understanding of the clinical significance of meniscal tears and appropriate patient management. It has also extended our understanding of the prevalence and importance of x-ray and arthroscopically occult bone, tendon and ligament injuries. By knowing the pathogenic mechanisms of disease, we can more reliably diagnose and treat pathology. In particular, many horizontal degenerative tears in older patients may be asymptomatic and are best left in place. Many acute tears may be best treated with immediate meniscal repair. MR imaging can reliably different these tear types with non-invasive imaging. MR's ability to detect bone injuries may lead to aggressive early non-weightbearing on injured bone, thereby preserving the subchondral bone from collapse and the joint from secondary osteoarthrosis. MRI's ability to detect and stage degenerative tendonosis of tendons and ligaments, such as the rotator cuff, may lead to arthroscopic decompression or debridement which provides symptomatic relief and may preserve and protect the intact cuff.