BACKGROUND Shoulder pain is one of the most common complaints encountered in clinical practice. It is also the commonest musculoskeletal ultrasound examination request. It often leads to considerable disability, hence an early diagnosis allows proper surgical treatment planning that can prevent functional impairment. Magnetic Resonance Imaging (MRI) is the state of the art diagnostic tool for evaluation of the shoulder. It allows the evaluation of the bone marrow, tendons, muscles, ligaments, capsules and bursae, but its limitations lie in the evaluation of the labrum and glenohumeral ligaments for which MRI arthrography is the study of choice. Improvement in the resolution of USG machines, refined techniques and better understanding of the pathology have contributed to high accuracy in the diagnosis of rotator cuff pathology. With an experienced sonologist and good equipment, accuracy of USG equals that of MRI for full-thickness tears and is slightly better than MRI for partial-thickness tears. USG's real-time capability, low cost and dynamic nature makes it the preferred imaging modality over MRI in several institutes. MATERIALS AND METHODS The present study is a case series study carried out at Katuri Medical College and Hospital in the Department of Radiodiagnosis and includes 50 patients with the complaint of shoulder joint pain with suspected rotator cuff pathologies, were evaluated p with ultrasound examination which was further followed by MRI and the results were compared and analysed for significance. Machines used-USG-Philips Envisor, GE LOGIQ F8, MRI-GE 0.2 Tesla machine. RESULTS 50 patients with shoulder pain with a clinical suspicion of rotator cuff tear were evaluated. USG examination of the affected shoulder was done in comparison with the normal shoulder and the findings were correlated with the subsequent MRI findings. Ultrasound can be used for the initial investigation of suspected rotator cuff pathologies. Advantages of ultrasound are noninvasive, real time, low cost, no radiation and the advantage of dynamic examination and comparison with the normal side. CONCLUSION In our study of 50 patients with suspected rotator cuff pathology, ultrasound demonstrated a high sensitivity and specificity more so for supraspinatus tendon pathologies and least for peribicipital tendon fluid collection and SASD bursitis. Also USG is a reliable dynamic diagnostic tool and provides direct correlation of the imaging findings with the symptoms of the patient, and helps with guided interventional procedures. Therefore, it should be considered as an accurate modality for the initial investigation of rotator cuff, especially supraspinatus tears. MRI is preferably done after sonography in doubtful cases or for evaluation of shoulder pathologies like labral tears.