Rotator cuff injury is a disease in which the muscle and tendon that constitute the rotator cuff are torn causing shoulder pain and limited function. Osteoporosis (OP) is a systemic metabolic bone disease characterized by decreased bone mass, destruction of bone microstructure, decreased bone strength, and increased bone fragility. Both are common musculoskeletal diseases that occur in middle-aged and elderly people, and their prevalence gradually increases with age. Clinically, rotator cuff injury and OP comorbidity are very common, especially in terms of bone metabolism. In recent years, plant natural products have gradually become a research hotspot. Icariin (ICA) is one of the naturally present active ingredients derived from the Berberaceae herb Epimedium. It has various pharmacological effects, such as anti-inflammatory, antioxidant, and anti- tumor properties, and is involved in the regulation of bone metabolism, which can play multiple therapeutic effects through a variety of proteins, receptors, and signaling pathways. Therefore, ICA, as a potential natural drug, is being gradually applied in the treatment of rotator cuff injury combined with OP, which has achieved great clinical efficacy. This study mainly discusses the pharmacological action and action mechanism of ICA in order to explore the potential of ICA to prevent and treat rotator cuff injury combined with OP and provide a theoretical basis for the subsequent clinical application of ICA.