Shoulder pain is a common problem and the third most common musculoskeletal symptom for which patients seek medical care. Rotator cuff tendinosis is a frequent cause of this pain and can be diagnosed clinically with a careful history and physical exam. Treatment consists of a trial of pain management and physiotherapy and imaging modalities are often not required. However, imaging can be highly valuable for other pathologies. This article guides the reader through key elements to include in a history and physical exam of the shoulder, and how and when to select an appropriate imaging modality.