Rotator Cuff Abnormalities Nearly Universal After 40, Study Questions Routine Shoulder MRI Use
Finland: A large population-based study from Finland has found that structural abnormalities in the rotator cuff are almost universal in adults over 40 years of age, regardless of whether they have shoulder pain. The findings, published in JAMA Internal Medicine by Thomas Ibounig and colleagues from the Finnish Centre for Evidence-Based Orthopaedics at the University of Helsinki, challenge the routine use of imaging in evaluating atraumatic shoulder pain.
Shoulder pain is one of the most frequent musculoskeletal complaints in clinical practice and is commonly attributed to rotator cuff pathology. Magnetic resonance imaging (MRI) is often used to identify tendon damage, yet the link between imaging findings and symptoms has remained uncertain. To address this gap, researchers conducted a cross-sectional study involving 602 adults aged 41 to 76 years drawn from a nationally representative Finnish population sample.
Participants underwent structured interviews, standardized questionnaires, clinical shoulder examinations, and bilateral 3-Tesla shoulder MRI between February 2023 and April 2024. Individuals with prior shoulder replacement surgery were excluded. Rotator cuff status on MRI was categorized as normal, tendinopathy, partial-thickness tear (PTT), or full-thickness tear (FTT). Shoulder symptoms were defined as pain or functional limitation during the preceding week.
Key Findings:
- Rotator cuff abnormalities were highly prevalent, with 98.7% of participants showing at least one abnormality on MRI.
- Tendinopathy was identified in 25% of individuals, partial-thickness tears in 62%, and full-thickness tears in 11%.
- Both the prevalence and severity of abnormalities increased with advancing age.
- No significant differences in abnormality rates were observed between men and women.
- Abnormal findings were common in both symptomatic and asymptomatic shoulders.
- Among asymptomatic shoulders, 96% demonstrated rotator cuff abnormalities.
- Among symptomatic shoulders, 98% showed similar abnormalities.
- Full-thickness tears appeared more frequently in symptomatic shoulders (14.6%) compared to asymptomatic shoulders (6.5%), but this difference was not statistically significant after adjustment for demographic variables, additional MRI findings, and clinical examination results.
The authors conclude that rotator cuff abnormalities appear to be nearly ubiquitous after age 40 and show limited correlation with current symptoms. These structural changes may therefore reflect normal age-related degeneration rather than a direct cause of pain. The findings call into question the clinical value of routine imaging for atraumatic shoulder pain and support a more cautious interpretation of MRI findings.
The study has limitations. Noncontrast MRI was used instead of MRA, though prior reviews show similar diagnostic accuracy. As participants were from the general population, the sample likely reflected milder disease than specialty settings. Large tears were uncommon, limiting conclusions for severe cases. The 41–76 year age range limits generalizability to younger adults, and language criteria may have reduced ethnic diversity.
Overall, the investigators suggest that reframing many rotator cuff findings as age-associated changes rather than disease could reduce unnecessary interventions, minimize patient anxiety, and help curb overdiagnosis and overtreatment in shoulder care.
Reference:
Ibounig T, Järvinen TLN, Raatikainen S, et al. Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging. JAMA Intern Med. Published online February 16, 2026. doi:10.1001/jamainternmed.2025.7903
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