Image-guided shoulder interventions have emerged as essential tools in the management of common shoulder complaints, necessitating a comprehensive understanding of the complex shoulder anatomy and the relevant imaging modalities. Fluoroscopy and ultrasound are the primary imaging techniques, each tailored to specific procedural goals, with fluoroscopy effectively visualizing joints such as the glenohumeral joint, while ultrasound is preferred for soft tissue interventions. Proper patient preparation and careful selection of injectable agents—including local anesthetics, corticosteroids, and platelet-rich plasma—are vital for minimizing risks and optimizing outcomes. The management of rotator cuff disorders, particularly through targeted injections and ultrasound guidance, demonstrates significant promise in alleviating pain and promoting healing. Key interventions address pain in structures such as the subacromial space, glenohumeral joint, scapulothoracic joint, and biceps tendon, enhancing rehabilitation efforts, particularly for conditions like adhesive capsulitis and scapulothoracic bursitis. As imaging technologies advance, including the integration of robotics and MRI-guided approaches, the precision and efficacy of shoulder interventions are expected to improve, ultimately leading to better patient outcomes.