The clinical evaluation of the painful shoulder by an experienced and knowledgeable health care professional remains the most sensitive and clinically useful tool for the assessment of most patients with rotator cuff disease, glenohumeral instability, glenohumeral arthritis, and adhesive capsulitis. The judicious and appropriate use of diagnostic imaging studies requires a thoughtful and thorough evaluation of the data obtained from these studies and their correlation to the patient's symptoms, history, mechanism of injury, and physical findings. The appropriate use of all of this diagnostic information should result in a precise, complete, and accurate diagnosis for most patients with shoulder pain.