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To compare risk factors for shoulder pain without and with rotator cuff syndrome (RCS).A total of 3,710 workers of a French region were randomly included in the cross-sectional study between 2002 and 2005. Personal and occupational risk factors were assessed during a physical examination and by a self-administered questionnaire. Multinomial logistic modeling was used for the following outcomes: no shoulder pain and no RCS (reference), shoulder pain without RCS (called “shoulder pain”) and RCS, separately for men and women.The prevalence rates of “shoulder pain” for men and women were 28.0% and 31.1%, respectively, and the prevalence rates of RCS were 6.6% and 8.5%, respectively. In men, “shoulder pain” and RCS were associated with age, high-perceived physical exertion, and arm abduction. Automatic work pace and low supervisor support were associated with “shoulder pain,” and high psychological demand and low skill discretion with RCS. In women, “shoulder pain” and RCS were associated with age, repetitiveness of tasks, and low supervisor support. High perceived physical exertion and exposure to cold temperatures were associated with “shoulder pain.”Age was more strongly associated with RCS than with shoulder pain without RCS for both genders. Biomechanical and psychosocial factors were associated with “shoulder pain” and RCS and differed between genders. Am. J. Ind. Med. 55:605–615, 2012. © 2011 Wiley Periodicals, Inc.