TOPLINE: 

Most adults over age 40 years had abnormalities on MRI in the rotator cuff. This was as common in people without shoulder pain or dysfunction as in those with symptoms.

METHODOLOGY:

• Researchers conducted a cross-sectional study to estimate the commonality of rotator cuff abnormalities on MRI in the general population — and how they related to symptoms in the shoulder.
• They included 602 adults aged 41-76 years (median age, 58 years; 52% women) from a Finnish cohort between February 2023 and April 2024.
• Participants completed interviews and questionnaires and had a clinical shoulder examination. Shoulder symptoms were defined as pain or dysfunction in the preceding week.
• Both shoulders were scanned with MRI, and the status of each tendon was classified as normal, tendinopathy, partial-thickness tear, or full-thickness tear.

TAKEAWAY:

• Researchers found rotator cuff abnormalities in 98.7% of participants, with 25% showing tendinopathy, 62% partial-thickness tears, and 11% full-thickness tears.
• Rotator cuff abnormalities were present in 96% of asymptomatic shoulders and 98% of symptomatic shoulders.
• The prevalence of abnormalities increased with age and did not differ between men and women.

IN PRACTICE:

“Reframing many of these findings as normal age-related changes rather than disease may help guide more appropriate care and reduce unnecessary interventions. In this context, adopting more precise and less value-laden terminology may help avoid language that implicitly suggests that something is broken and requires fixing,” the researchers wrote.

“The findings of this study are not meant to dissuade clinicians from using MRI when appropriate, but to reinforce that the diagnosis and management of shoulder pain should be guided primarily by functional limitations,” Edgar Garcia-Lopez, MD, and Brian T. Feeley, MD, wrote in an invited commentary accompanying the study.

SOURCE:

The study, led by Thomas Ibounig, MD, University of Helsinki in Finland, was published online February 16 in JAMA Internal Medicine.

LIMITATIONS: 

The sample likely included milder cases and few large tears, limiting analysis of severe disease. The age range and requirement to speak Finnish or Swedish limited generalizability and diversity. Noncontrast MRI may not have accurately identified small or partial tears.

DISCLOSURES:

The study received support from the Academy of Finland and the Social Insurance Institution of Finland, among others. Various authors reported receiving support from the Australian National Health and Medical Research Council and being a board member of the Finnish Society for Shoulder and Elbow Surgery, among other disclosures.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.