Background: Shoulder pain is a common complaints encountered in rheumatoid arthritis (RA) patients. Through the first two years of RA, nearly 50% of patients have shoulder symptoms, and 90% complain of shoulder pain at some time during the course of the disease. Objectives: to identify the ultrasound (US) abnormalities in RA patients with shoulder pain and to correlate them with clinical and laboratory parameters of the disease. Methodology: A case control cross sectional study was performed on 50 RA patients with shoulder pain satisfying the 2010 ACR/EULAR criteria, and 30 age and sex matched volunteers complain of shoulder pain serving as controls. US assessment was performed bilaterally in RA patient's shoulder and control's shoulder. Results: The most common shoulder image abnormalities in RA patients were subacromial-subdeltoid (SASD) chronic bursitis and glenohumeral joint (GHJ) effusion in 38% of patients' shoulders, acromioclavicular joint (ACJ) irregularity in 35% of patients' shoulders, and supraspinatus tendinopathy in 34% of patients' shoulders. There was a significant relation between shoulder pain and US detected full thickness tear of supra-spinatus tendon (p=0.025), SASD chronic bursitis (p=0.033), humeral bone irregularity (p=0.049), ACJ irregularity (p=0.002) and GHJ effusion (p=0.033). There was a significant relation between disease activity and US-detected humeral bone erosions (p=0.002), ACJ synovitis (p=0.021), and ACJ osteophytes (p=0.025). Conclusion: US imaging is an important additional tool that supplements conventional radiography of the shoulder joints in RA.