Extrinsic compression of the rotator cuff by the coracoacromial arch has been accepted as a major factor in the etiology of bursitis, cuff tendonitis, and rotator cuff tears. Other etiologies for rotator cuff syndrome have also been proposed in various patient populations. These include repetitive microtrauma and underlying instability with tensile overload, particularly in the younger (younger than 35) athletic population. In this evolving field, the arthroscopist must to be able to recognize arthroscopic signs of impingement syndrome. Therefore, this paper discusses evaluating rotator cuff syndromes and reviews the signs of subacromial impingement found at bursoscopy. We also offer several tips to maximize visualization during shoulder bursoscopy.