Acute shoulder injury is commonly encountered by clinicians, surgeons, and radiologists. A comprehensive evaluation of the shoulder by the radiologist is essential to accurately relay findings that have a direct impact on acute and long-term management. In this review, imaging features of acute injuries involving the proximal humerus, glenohumeral joint, rotator cuff, tendon of the long head of the biceps brachii, and acromioclavicular joint are discussed. Modalities include ultrasound examination, conventional radiography, computed tomography scans, and MR imaging. Emphasis is placed on radiographic features that have an impact on patient management.