Rotator cuff tendinopathy is a common musculoskeletal disorder with increasing incidence with age. Conservative management includes NSAIDs, physical therapy, rehabilitation exercises, corticosteroid injections, platelet-rich plasma, and hyaluronic acid (HA). This narrative review evaluated the procedural considerations and clinical efficacy of HA injections in rotator cuff tendinopathy. A literature search of PubMed/MEDLINE and the Cochrane Central Register of Controlled Trials identified relevant studies published through September 2024. Eleven clinical studies, including nine randomized controlled trials and two prospective non-randomized studies, were analyzed. Compared with saline, most studies demonstrated favorable pain and functional outcomes lasting up to one year. HA injections showed comparable or superior efficacy to corticosteroid injections, with fewer adverse effects and no detrimental tendon tissue effects. Combined HA and platelet-rich plasma therapy yielded the best long-term outcomes. Different molecular weights of HA demonstrated similar efficacy, although low-molecular-weight HA was associated with less post-injection soreness. Ultrasound guidance improved injection accuracy and clinical outcomes.