• Dyson-Hudson TA and Kirshblum SC (2004). Shoulder pain in chronic spinal cord injury, Part I: Epidemiology, etiology, and pathomechanics. J Spinal Cord Med. 27: 4-17. Kessler Medical Rehabilitation Research and Education Corporation, Spinal Cord Injury Rehabilitation Research, West Orange, New Jersey 07052, USA. tdyson-hudson@kmrrec.org. STUDY DESIGN: Review of the literature. BACKGROUND/OBJECTIVE: Shoulder pain is extremely common in individuals with chronic spinal cord injury (SCI) and is a source of morbidity and functional loss. The purpose of this review is to outline the present knowledge of the epidemiology, etiology, and pathomechanics of musculoskeletal shoulder pain in individuals with chronic SCI. METHODS: Review of the literature using PubMed/MEDLINE, EMBASE, and bibliographies of selected articles. RESULTS: Shoulder pain is more common in individuals with tetraplegia and complete injuries and may occur more frequently in women. Musculoskeletal conditions, primarily injuries to the rotator cuff, are most common. Risk factors include the duration of injury, older age, higher body mass index, the use of a manual wheelchair, poor seated posture, decreased flexibility, and muscle imbalances in the rotator cuff and scapular stabilizing muscles. CONCLUSION: With a better understanding of the epidemiology, etiology, and basic pathomechanics of shoulder pain in SCI, physicians are in a better position to evaluate, treat, and prevent these disorders.