Shoulder pain and dysfunction are common problems among those individuals with a spinal cord injury (SCI). Among individuals with SCI who have shoulder pain, the prevalence of rotator cuff tears is 65 TO 71%. To date, there has been little discussion as to the efficacy of various treatments for shoulder pain used in the SCI population. The purpose of this retrospective study was to evaluate the outcome of rotator cuff repairs at the Spinal Cord Injury Center (Veterans Administration Puget Sound Health Care System). Five patients (six shoulders) were identified who had undergone shoulder surgery for rotator cuff tear since 1987. Four individuals (five shoulders) had large rotator cuff tears, and following surgery, none of these repairs resulted in improvement of shoulder function or improvement in active range of motion. The one patient with a smaller tear limited to the supraspinatus had a successful surgical outcome in that he had decreased pain, increased strength, and increased range of motion. There is a general lack of epidemiologic information about shoulder pain in individuals with paraplegia. There is also a remarkable lack of research as to the functional impact of shoulder pain and the outcome of nonsurgical and surgical treatments. This case series, drawn from a population of 511 individuals with spinal cord injury, demonstrates that poor outcome was more likely in those with supraspinatus atrophy, those with upward displacement of the humeral head on x-ray, and in those with tears involving more than one muscle. There is a need for further study of conservative treatment and development of selection criteria for those individuals who are being considered for surgery.