Objective This study aimed to highlight the diagnostic value of musculoskeletal ultrasonography (US) in the evaluation of inflammatory changes in the shoulders of rheumatoid arthritis (RA) patients and to correlate those findings with the clinical, laboratory, and radiological parameters of the disease activity. Patients and methods This study included 40 RA patients diagnosed according to the 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for RA. In addition, 20 age-matched and sex-matched healthy individuals were included. US assessment was performed bilaterally in RA patient’s shoulder and unilaterally in controls. All US examinations were carried out using LOGIQ P6 PRO machine equipped with 6–8 MHz broadband multifrequency linear transducer. Result US on shoulders detected that 21 (52.5%) RA patients studied had erosions, 18 (45%) RA patients had synovitis, 21 (52.5%) RA patients had tenosynovitis, seven (17.5%) RA patients had bursitis, and 18 (45%) RA patients had rotator cuff tendinopathy. There was a significant relation between US-detected erosion in RA patients and disease duration (P = 0.037) and rheumatoid factor (RF) level (P = 0.02), whereas there was no significant relation between US-detected erosion in RA patients and shoulder pain (P = 0.185), Disease activity score 28 (DAS28) (P = 0.163), erythrocyte sedimentation rate (P = 0.519), and C-reactive protein levels (P = 0.561). There was a significant relation between US-detected tenosynovitis in RA patients and shoulder pain (P = 0.025). There was no significant relation between US-detected bursitis in RA patients and disease duration (P = 0.970), shoulder pain (P = 0.907), DAS28 (P = 0.471), erythrocyte sedimentation rate (P = 0.220), and RF levels (P = 0.755), whereas there was a significant relation between US-detected bursitis in RA patients and C-reactive protein (P = 0.036). Conclusion US became a problem-solving approach and the tool of choice for cases with shoulder problem, and can provide an accurate answer to many clinical questions and give an accurate diagnosis of different