[Objective] To evaluate the value of X-ray combined with MRI in the diagnosis of rotator cuff injury. [Methods] A retrospective study was conducted on the patients who underwent X-ray and MRI examinations at the First Affiliated Hospital of Air Force Medical University from January 2021 to March 2022. A total of 158 patients were recruited, among whom 146 had rotator cuff injury, 10 had rheumatoid arthritis, and 2 had shoulder joint space occupation. We compared the specificity, sensitivity, consistency, detection rate, missed diagnosis rate and misdiagnosis rate of various examinations, and compared the X-ray and MRI examination results. [Results] The sensitivity and specificity of X-ray for rotator cuff injury were 65.8% and 41.7%, those of MRI for rotator cuff injury were 78.1% and 66.7%, and those of the combined diagnosis were 93.8% and 83.3%, respectively. The Kappa value of the combined diagnosis of rotator cuff injury and surgical results was higher than that of X-ray and MRI diagnosis (P<0.05). The detection rate and missed diagnosis rate of the three groups differed significantly (χ²=6.095, 13.113, P<0.05). The detection rate of rotator cuff injury by the combined diagnosis was higher than that of X-ray and MRI diagnosis, and the missed diagnosis rate was lower than that of the latter (P>0.05). [Conclusion] The detection rate of rotator cuff injury of shoulder joint by the combined examination is higher than that of X-ray and MRI, and the rate of missed diagnosis and misdiagnosis is lower. The combined examination can provide detailed evaluation for preoperative diagnosis.