Overuse Injuries of the Shoulder

Shoulder overuse injuries represent a broad and often overlapping spectrum shaped by repetitive loading, soft tissue adaptation, and changes in bone. Rather than distinct entities, they are better viewed along a continuum, where repeated microtrauma gradually leads to structural and functional alterations in tendons, capsulolabral structures, bursae, and bone. This narrative review covers the broad anatomical spectrum of shoulder overuse injuries, including rotator cuff disorders, impingement syndromes, labral and capsular abnormalities, biceps tendon pathology, bursal disease, and osseous and physeal injuries. Imaging alone is not always sufficient for diagnosis because many findings, especially in the rotator cuff, may also be present in asymptomatic individuals. Therefore, imaging should be interpreted in the context of the patient's clinical presentation and biomechanical factors. Magnetic resonance imaging remains central for structural assessment, whereas dynamic ultrasonography adds real-time functional information. Emerging techniques such as shear wave elastography may further improve evaluation by providing quantitative data. In practice, combining these approaches improves diagnostic confidence and helps guide management, with ongoing advances expected to further refine clinical decision-making.