In this article for Becker's Orthopedic Review, Dr. Don A. Buford explains both the clinical evidence and benefits for the use of diagnostic ultrasound for shoulder evaluation. In particular, evidence for the use of ultrasound as the first imaging study in cases of suspected rotator cuff tear. Dr. Buford, an orthopedic surgeon, also covers the benefits of ultrasound to patients, his clinical practice and the costs to the healthcare system. As the healthcare system moves toward both Appropriate Use Criteria for imaging and lower costs, this article explains why it is time to implement such practices.