03/25/2026
Imaging can be useful but here’s some more data supporting the limitations of its use!
Many asymptomatic people display an anatomical rotator cuff abnormalities WITHOUT accompanying symptoms.
Importantly:
👉 abnormalities increased with age beginning with tendinopathy as a common finding in 45-54 and increasing damage after that
👉 worse damage was associated with more likelihood of symptoms
👉 no substantial differences between genders
👉 most abnormalities were found in asymptomatic individuals underlaying the poor causality between symptoms and imaging
“Consequently, a positive MRI result does not confirm causality unless features such as a clear traumatic event, acute strength loss, or persistent functional deficit increase the pretest probability.”
So that tear you see on the MRI? Do we really know that it wasn’t already there when you started developing pain recently? NO. Yet we are so quick to push people towards surgeries 👉 maybe this is why we see a lot of sham surgeries having similar outcomes 🤷♂️
Unless there is
👉 clear mechanism of injury
👉 acute strength loss
👉 lack of improvement with skilled care
… we CANNOT say that the abnormality found on imaging alone is the cause for the dysfunction.
The shoulder is a complicated beast, sometimes the issue doesn’t lay within the first hypothesis we think we identify 🧐
Further reading 📖:
Ibounig, T., Järvinen, T. L. N., Raatikainen, S., Härkänen, T., Sillanpää, N., Bensch, F., Haapamäki, V., Toivonen, P., Björkenheim, R., Ryösä, A., Kanto, K., Lepola, V., Joukainen, A., Paavola, M., Koskinen, S., Rämö, L., Buchbinder, R., & Taimela, S. (2026). Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging. JAMA internal medicine, e257903. Advance online publication. https://doi.org/10.1001/jamainternmed.2025.7903
