Background: Commercial truck drivers (CTDs) are significantly affected by shoulder injuries; however, little is known about the unique mechanisms of injury (MOIs), specific injuries, or possible preventive measures among this group of workers. This study characterized the MOIs, musculoskeletal disorders (MSDs), and factors associated with MSDs of the shoulder among a group of CTDs. Methods: A retrospective medical record review was conducted of CTDs between 21 and 65 years of age who were seen for MSDs of the shoulder between 2007 and 2015. Results: A total of 130 CTDs were included, who were aged 21 to 65 years. Commercial truck drivers were most often injured during a fall (35%) or while using chains, tarps, or straps (31%). The two most common MSDs were unspecified sprains/strains (58%) and rotator cuff tears (24%). Age was found to be associated with all MSDs (p =.001) and an increased risk of developing rotator cuff tears (p =.005). Seventy-four percent of CTDs who experienced a rotator cuff tear were 46 years of age or older. Conclusion/Application to Practice: This study highlights the course of the injury in terms of diagnostics such as magnetic resonance imaging (MRI) and referral for surgery and describes the occupational activities associated with CTDs. These findings can inform employer injury prevention programs, patient and health care provider education, and future interventional research.