Although many wheelchair users report shoulder pain, the prevalence of specific pathologies remains controversial. Rotator cuff impingement, glenohumeral instability, and biceps tendonitis have been stated as the most commonly found pathology. This study investigated the prevalence and identity of shoulder pathology in athletic and nonathletic manual wheelchair users (MWCUs). Fifty-two MWCUs (26 athletes, 26 nonathletes) completed a survey regarding the nature of their injury, sports involvement, history, and presence of current and/or past shoulder pathology. Subjects currently experiencing shoulder pain underwent a clinical examination of both shoulders. Analysis of variance (p <or=0.05) determined if differences existed between the groups in demographic variables, history of shoulder pain, and clinical evaluation measures in those with shoulder pain. Chi-squared (p <or=0.05) analysis verified the frequency distribution and association by groups and involved limbs for the clinical shoulder test measures. No difference was found in the incidence of shoulder pain, past or present, between athletes and nonathletes. Collectively, 61.5% (32/52) of the subjects reported experiencing shoulder pain, with 29% reporting shoulder pain at the present time. Years since onset of disability (p = 0.01) and duration of wheelchair use (p = 0.01) were found to be greater in individuals who reported a history of shoulder pain. Of the painful shoulders tested, 44% revealed clinical signs and symptoms of rotator cuff impingement, while 50% revealed signs of biceps tendonitis. Instability was found in 28% of the painful shoulders. These findings indicate that involvement in athletics neither increases nor decreases the risk of shoulder pain in the manual wheelchair population. Bicipital tendonitis with impingement syndrome was the most common pathology.