Cumulative six-quarter free cash flow burn reached $60.7 million, with 2026Q2 capex of $2.2 million (12.6% of revenue) far exceeding $1.1 million of depreciation and working capital absorbing cash as revenue scaled, implying burn has not yet decelerated with growth.
Shoulder Innovations, Inc. (SI) cash flow statement — 3-year operating, investing & financing cash flows
| Metric | TTM | Dec'25 | Dec'24 | Dec'23 |
|---|
| Cash from Operations | -34.92M | -28.61M | -14.14M | -13.14M |
| Operating CF Margin % | - | -60.47% | -44.72% | -68.2% |
| Operating CF Growth % | -119.61% | -102.31% | -7.6% | - |
| Net Income | -33.35M | -40.36M | -15.62M | -12.65M |
| Depreciation & Amortization | 4.36M | 3.21M | 2.2M | 1.64M |
| Stock-Based Compensation | 3.21M | 996K | 754K | 451K |
| Deferred Taxes | 0 | 0 | 0 | 0 |
| Other Non-Cash Items | -6.62M | 14.29M | -437K | 2.18M |
| Working Capital Changes | -2.52M | -6.75M | -1.04M | -4.76M |
| Change in Receivables | -2.58M | -3.3M | -575K | -2.69M |
| Change in Inventory | -5.02M | -7.64M | -4.03M | -2.41M |
| Change in Payables | -1.84M | 3.37M | 3.12M | -737K |
| Cash from Investing | 18.17M | -95.6M | 13.96M | -28.97M |
| Capital Expenditures | -7.76M | -7.41M | -4.01M | -2.75M |
| CapEx % of Revenue | 12.03% | 15.66% | 12.7% | 14.26% |
| Acquisitions | 0 | 0 | 0 | 0 |
| Investments | - | - | - | - |
| Other Investing | 0 | 0 | 0 | 0 |
| Cash from Financing | -1.77M | 144.96M | 66K | 44.73M |
| Debt Issued (Net) | 0 | 0 | 0 | 10M |
| Equity Issued (Net) | -39.03M | 144.96M | 66K | 34.88M |
| Dividends Paid | 0 | 0 | 0 | 0 |
| Share Repurchases | 0 | 0 | 0 | 0 |
| Other Financing | 37.26M | 0 | 0 | -149K |
| Net Change in Cash | -18.52M | 20.75M | -113K | 2.61M |
| Free Cash Flow | -42.69M | -36.02M | -18.16M | -15.89M |
| FCF Margin % | -66.19% | -76.12% | -57.42% | -82.45% |
| FCF Growth % | - | -98.37% | -14.26% | - |
| FCF per Share | -2.05 | -1.75 | -0.91 | -0.80 |
| FCF Conversion (FCF/Net Income) | 1.28x | 0.71x | 0.91x | 1.04x |
| Interest Paid | 394K | 1.69M | 1.78M | 901K |
| Taxes Paid | 0 | 0 | 0 | 0 |
Quick answers to the most common questions about buying SI stock.
Shoulder Innovations, Inc. (SI) generated $-28.6M in net cash from operating activities in 2025. This reflects the cash generated directly from core business operations.
Shoulder Innovations, Inc. (SI) reported negative free cash flow of $36.0M in 2025, indicating capital requirements exceeded cash from operations.
Shoulder Innovations, Inc. (SI) spent $7.4M on capital expenditures in 2025. CapEx represents the cash invested in physical assets like property, plant, and equipment to maintain or grow the business.
Key Metrics
Top Statement Risk
Cash burn exceeds revenue scaling
Metrics are mathematically derived from official filings.
Cash Conversion Stays Negative as Losses Persist
Operating cash flow of negative $7.4 million in 2026Q2 compared with a negative $10.2 million net loss implies a modestly narrower outflow than the reported loss, yet the six-quarter operating cash outflow totaled negative $48.5 million according to the quarterly statements reviewed.
The OCF/NI ratio has oscillated sharply, from 0.25 in 2025Q2 to 1.47 in 2026Q1, meaning that cash outflow has repeatedly exceeded the net loss once working capital swings are layered in — in 2026Q1 a $5.8 million working-capital use turned an $8.4 million net loss into a $12.4 million operating cash drain. Non-cash items currently cushion reported earnings, with D&A of roughly $1.1 million per quarter, but investors should note that these add-backs appear to mask rather than offset structural losses. The 2026Q2 ratio of 0.73 hints at a modest sequential improvement, though on a company still posting an operating deficit, positive conversion remains unproven.
Capital Program Scales Ahead of Depreciation
Capital expenditure of $2.2 million in 2026Q2 equated to 12.6% of quarterly revenue, up from 8.3% in 2025Q1 and peaking at 23.9% in 2025Q3, based on the reported cash flow statements, while cumulative six-quarter capex of roughly $12.4 million far exceeded depreciation of about $5.4 million.
Capex intensity more than doubled inside six quarters, and the widening gap between cumulative capital spending and accumulated depreciation suggests the investment profile is closer to growth than maintenance in nature. This matters for a business already consuming cash: every incremental dollar of machinery or infrastructure is currently absorbed before any operating leverage from the revenue scale-up shows up in cash flow. Capex as a share of revenue eased to 12.6% in 2026Q2, but that ratio remains roughly 150% of the 2025Q1 level, so the capital drag on liquidity appears persistent rather than transitional.
Working Capital Absorbs Cash as Revenue Scales
Working capital consumed $5.8 million of cash in 2026Q1 alone and negative $13.0 million cumulatively over six quarters, according to the quarterly filings, even as revenue expanded from $10.1 million to $17.2 million, absorbing cash faster than the top line grew.
The pattern of cash uses in receivables and inventory appears consistent with a commercial operation ramping distribution ahead of collections, but the magnitude relative to revenue suggests the cycle has not yet turned favorable. Notably, the largest single working-capital drag occurred in the very quarter (2026Q1) where the income statement analysis identified the spend-driven inflection, implying that growth may be pulling cash out of the business through the balance sheet at the same time it is pulling it out through SG&A. Only 2025Q2 posted a positive working-capital contribution, and it coincided with an anomalous $19.2 million net loss, so the improvement signals are weak.
Cumulative Burn Tracks Losses With Little Cushion
Shoulder Innovations posted cumulative net losses of $59.0 million and cumulative operating cash outflows of $48.5 million across the six reported quarters, with cumulative free cash flow burn reaching $60.7 million as shown in the company's financial statements.
The near-parity between cumulative net loss and cumulative free-cash-flow burn indicates that the accrual cushion investors might otherwise expect from non-cash charges has been largely consumed by capital spending and working-capital needs. This means the reported profitability gap is not being offset by cash generation: each dollar of reported loss has translated almost one-for-one into cash consumed, and in two of six quarters (2026Q1 and 2025Q3) the free-cash-flow loss materially exceeded the net loss. For an equity-funded growth story, the absence of any sustained positive cumulative operating cash flow across the window warrants further investigation into the pace at which the deficit is narrowing.
SBC and Unreconciled Adjustments Cloud the Picture
Stock-based compensation rose to $1.1 million in 2026Q2, or about 6.4% of revenue, per the company's reported statements, and the disclosed D&A, SBC, and working-capital items do not fully reconcile the $59.0 million net loss to the $48.5 million operating cash outflow.
SBC grew roughly 8.7-fold over six quarters while revenue grew about 70%, so the non-cash add-back that flatters the operating-cash-flow bridge is itself expanding faster than the top line; had this charge been cash-settled or treated as dilutive economics, the reported loss would look materially worse. Separately, the visible components — D&A, SBC, and working-capital movements — sum to a figure that does not fully account for the gap between net income and operating cash flow, implying additional non-cash adjustments exist that are not separately disclosed in the figures provided. The reported cash flow statement also excludes any disclosure of debt service, lease obligations, or financing flows in the data supplied, so the true cash burden of the operating model may extend beyond what this section can verify.