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Christina M Chingkoe1, Jeremy H White2, Luck J Louis2, Gordon Andrews2, Bruce B Forster21Faculty of Medicine, University of British Columbia, Vancouver BC, Canada; 2Department of Radiology, University of British Columbia, Vancouver BC, CanadaAbstract: Rotator cuff pathology is routinely evaluated in many imaging centers with both magnetic resonance imaging (MRI) and ultrasound. Despite good diagnostic accuracy using each of these modalities, certain limitations persist. In this pictorial essay, we describe five potential “troublemakers” of rotator cuff pathology which are recurrent themes in our busy shoulder referral center. The comparison of imaging findings on MRI and ultrasound are discussed. An awareness of these potential pitfalls will help improve radiologists’ diagnostic accuracy of rotator cuff pathology, and allow the clinician to optimize imaging referral and better interpret the subsequent report.Keywords: rotator cuff, ultrasound, MRI, correlation, shoulder