&NA;The shoulder is among the most difficult joints to image well using ultrasound, likely contributing to the wide range of reported success of ultrasound in diagnosing rotator cuff tears. Using well defined techniques and criteria, recent studies have demonstrated very favorable results in detecting rotator cuff pathology using ultrasound. Special attention must be given to the potential pitfalls due to tendon curvature and the complex anatomy of the rotator cuff, as well as to using appropriate equipment. Current literature demonstrates a sensitivity of 91 to 95% and approximately 90% specificity and accuracy in the assessment of both partial‐ and full‐thickness tears using ultrasound.Technical advances in ultrasound imaging are expected to further expand the role of ultrasound in the evaluation of rotator cuff pathology by offering improved image quality and reducing its inherent operator dependence. These include tissue harmonic imaging, extended field‐of‐view imaging, and 3‐dimensional imaging. The real‐time nature of ultrasound permits dynamic assessment of shoulder stability, tendon subluxations, as well as allowing accentuation of cuff tears. This review will covers the sonographic anatomy, scanning techniques, and pathology of the rotator cuff and long head of biceps tendons, emphasizing recent advances in ultrasound technology as these apply to the rotator cuff. Examples of the sonographic appearances following cuff repair and in the presence of a shoulder replacement will also be included.