A total of 15 randomized controlled trials (RCTs) were included in this systematic review to determine the efficacy and safety of different forms of acupuncture in the management of musculoskeletal disorders. Ten trials reported on musculoskeletal disorders of the upper extremities: three on carpal tunnel syndrome; two on lateral epicondylitis; four on shoulder pain; and one on general upper extremity pain. Five trials reported on musculoskeletal disorders of the lower extremity: two on knee pain; one on plantar fasciitis; one on Achilles tendinopathy; and one on piriformis syndrome. The evidence identified presented inconsistent results for the use of acupuncture for musculoskeletal disorders. Findings indicated that traditional needle acupuncture may be effective for carpal tunnel syndrome and Achilles tendinopathy, electroacupuncture may be effective for shoulder injuries and may be equally as effective as night wrist splinting for carpal tunnel syndrome. Finally, the use of dry needling for plantar fasciitis syndrome led to non-clinically relevant differences versus placebo, while traditional needle acupuncture was not effective for nonspecific upper extremity pain or patellofemoral syndrome. The results of this systematic review highlight the need for additional high-quality trials that utilize a uniform approach to evaluate the efficacy of acupuncture in the management of musculoskeletal disorders of the extremities.