This paper is designed to outline a routine shoulder examination, identify bony landmarks, discuss patient position, and outline the requirements for an ultrasound imaging room. Real-time high-resolution ultrasound is our preferred choice of imaging to evaluate rotator cuff pathology. Structures imaged routinely in real-time ultrasound are the biceps brachii long head, the subscapularis, the supraspinatus tendon and muscle belly, the infraspinatus, the subacromial bursa, subdeltoid bursa, and the posterior labrum and capsule. The structures that are not well demonstrated with ultrasound are the deep bones and labra of the shoulder joint. High-resolution, real-time ultrasound shows in considerable detail the intratendinous changes that commonly occur in rotator cuff pathology. Tendon tears are easily visualized, as are changes within the echo texture of the tendon.