Pain from rotator cuff pathology is a common problem in upper extremity athletes. Impingement of the rotator cuff tendons on the subacromial arch is an important cause. Primary age-related degeneration and instability, however, should not be forgotten as causes for cuff pathology. Conservative treatment is successful in many athletes. Surgical subacromial decompression is reserved for resistant cases. Although often helpful, surgical treatment generally requires a long recovery for throwing athletes and can be associated with residual symptoms.