Examination of the shoulder with ultrasound has become a widely accepted method of evaluating a number of musculoskeletal pathologies. The continuing advancements made in imaging technology have allowed ultrasound to develop into a powerful diagnostic tool. Ultrasound has the advantage of producing high-resolution dynamic images of the shoulder, as well as allowing the operator to perform image-guided interventions, such as cyst aspiration or steroid injections. Its main role has continued to be in diagnosing partial and fullthickness rotator cuff injuries, and it allows the assessment of size, location and extension of tears. It has good correlation to intra-operative findings and compares favourably to MRI, particularly in the diagnosis of partial rotator cuff tears. In experienced hands it provides a rapid and cost-effective evaluation of the painful shoulder. Ultrasound also provides information about intra-articular abnormalities, such as labral tears, loose bodies and synovial disease, as well as evaluating joint effusions and acromio-clavicular joint arthropathies.