A protocol including physical examination, plain radiography, and shoulder arthrography was designed to study prospectively the causes of shoulder pain in patients with cervical spinal cord injury. Twenty-four patients (30 shoulders) were studied and subdivided into acute and chronic groups. The causes of shoulder pain in the acute group of 11 patients (15 shoulders) included capsular contracture or capsulitis or both in 6 shoulders; rotator cuff tears in 4; anterior instability in 2; and rotator cuff impingement, osteoarthritis with osteonecrosis, and osteoarthritis in 1 each. Of 13 patients (15 shoulders) assigned to the chronic group, the diagnoses included anterior instability in 5 shoulders; multidirectional instability in 3; capsular contracture or capsulitis or both in 3; and Charcot arthropathy, rotator cuff tear, rotator cuff impingement, and scapular pain in 1 each. To prevent and treat shoulder pain, therapeutic protocols for these patients must be individualized after a correct diagnosis is made.