| Background: Shoulder impingement syndrome is a common musculoskeletal disorder causing pain and functional limitation of the shoulder joint. Conservative physiotherapy modalities such as ultrasound therapy and exercise therapy are commonly used for its management. This study aimed to compare the effectiveness of ultrasound therapy and exercise therapy in patients with shoulder impingement syndrome. Methods: This comparative interventional study was conducted at the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University from January 2017 to December 2017. A total of 40 clinically diagnosed patients with shoulder impingement syndrome were selected purposively and divided equally into two groups. Group A received ultrasound therapy, while Group B underwent exercise therapy. Pain intensity was assessed using the Visual Analog Scale (VAS) and shoulder functional status was evaluated before and after treatment. Data were analyzed using SPSS version 22. Results: The majority of patients belonged to the 31–40 years age group (42.5%) and males constituted 57.5% of the study population. Baseline VAS scores were similar between the ultrasound and exercise groups (7.4 ± 1.1 vs 7.2 ± 1.0; p=0.561). After treatment, the exercise therapy group demonstrated significantly greater pain reduction (3.7 ± 1.0 vs 2.6 ± 0.9; p=0.001) and better functional improvement (26.6 ± 5.1 vs 17.6 ± 4.5; p<0.001) compared to the ultrasound group. Conclusion: Both ultrasound and exercise therapy improved pain and shoulder function; however, exercise therapy was significantly more effective than ultrasound therapy in managing shoulder impingement syndrome.