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Shoulder pain is common in young athletes, particularly those involved in overhead sports when repetitive stresses are incurred by the dynamic and static stabilizers. The underlying pathology responsible for pain may be difficult to sort out because of the complex nature of shoulder mechanics and throwing. In older athletes true mechanical impingement is often the offending agent causing cuff tendinitis. However, young athletes more commonly suffer some subtle instability that leads to secondary impingement and cuff tendinitis. A keen understanding of shoulder mechanics and a thorough clinical and diagnostic evaluation will allow the orthopedist to identify the structures responsible for causing the shoulder pain and then tailor an appropriate treatment for that patient.