The shoulder girdle is a versatile anatomic structure with a wide range of mobility and function. Its soft tissue and skeletal components are subject to a litany of injuries, spanning overuse syndromes to acute trauma. The use of key history and physical examination techniques with proper imaging in the emergency department (ED) will aid in the diagnosis of specific disorders. Once a diagnosis is made, surgical consultation can be obtained versus more conservative therapy initiated, including immobilization or early rehabilitation.