Rotator cuff tears are one of the most common causes of shoulder pain. Determining rotator cuff integrity is pivotal in deciding between surgical and nonsurgical management. A combination of clinical history, physical examination, and imaging studies is needed to confirm the diagnosis. Given its comparable diagnostic accuracy, low cost, and convenience, high-frequency ultrasound may be considered prior to MRI, based on clinical determination via medical history, physical examination, and review of relevant imaging, for the evaluation of rotator cuff tears. Furthermore, the cost of MRI and some contraindications, like the presence of metal-mounted devices, could make ultrasound a better, more accessible option in certain clinical scenarios. A clinician skilled in diagnostic ultrasound could decide not to obtain an MRI for a rotator cuff tear if the diagnosis is clear after obtaining a good medical history, completing an adequate physical exam, and performing a good-quality diagnostic ultrasound. Ultrasound of the rotator cuff should be done by an experienced provider at a center with appropriate diagnostic ultrasound equipment.