Clinical Scenario: Until recently, injury epidemiology data on elite Paralympic athletes were limited. Current data suggest high rates of shoulder injury in wheelchair athletes. Differences in shoulder injury rates between sports have not been reported in this population. Clinical Question: Is the incidence of shoulder injury in elite wheelchair athletes different between sports? Summary of Key Findings: Shoulder injury rates are high in elite wheelchair athletes, particularly in sports such as field events and fencing that require a stable base (eg, trunk, core control) from which to perform. Wheelchair racing requires repetitive motions that contribute to shoulder injuries, but rates are lower than field sports and fencing. Wheelchair curling and sledge hockey have low shoulder injury risk. Clinical Bottom Line: Shoulder injury rates vary based on sport in elite wheelchair athletes. In addition to incorporating shoulder complex specific rehabilitation for overuse shoulder injuries, clinicians should focus on core and trunk stabilization in elite wheelchair athletes competing in sports, such as field events and fencing. Strength of Recommendation: Grade C evidence exists that reports shoulder injury rates among elite wheelchair athletes differ based on sport participation.Keyword: disabled training and conditioning, epidemiology, shoulder joint, Paralympic Clinical ScenarioThe inaugural Paralympic games were held in 1960, yet it was not until 1976 when injuries during the games were first documented. 1 There are limited epidemiological data on disabled athletes due to inconsistent documentation, lack of definitions of injuries, reliance on self-reporting, and lack of web-based injury surveillance systems. Ferrara and Peterson 1 conducted the first longitudinal study on 5 major elite paraevents using standardized procedures and equipment and reported injury rates in elite disabled athletes were comparable to elite able-bodied athletes. Their research also advocated for the development of standardized injury definitions, reporting more specific injury information (eg, wheelchair athletes by class and impairment), and data collection systems to enable higher quality epidemiological research of disabled athletes. 1 Continued efforts by several organizations to address identified barriers led to standardized injury definitions and injury rate calculations, and the implementation of an online web-based injury and illness surveillance system at the 2012 London Paralympic Games. 2,3 Establishing the infrastructure to support injury surveillance of elite disabled athletes facilitates consistent data collection and tracking methods across a variety of sports, body regions, and injuries. Information gained from injury surveillance enables researchers and clinicians to better understand injuries and the unique needs of this population, so more appropriate care can be provided. For example, wheelchair athletes present with unique demands and needs of their upper-extremity in daily life and sport, which may impact injury rat...