99% of adults over 40 have shoulder “abnormalities” on an MRI, study finds

Shoulder pain is incredibly common, and often leads to imaging tests like MRIs. But a new study is prompting a re-evaluation of how we interpret those results – and how doctors communicate them to patients. The research reveals a surprisingly high rate of “abnormalities” found on MRIs, even in people without shoulder pain, suggesting that what we consider “normal” shoulder structure may need to be redefined.

The Scope of the Findings

Researchers examined 1,204 shoulders. Of those, 90 percent – 1,076 shoulders – were asymptomatic, meaning the individuals experienced no pain. Yet, a striking 96 percent of those pain-free shoulders (1,039 total) showed some form of abnormality on MRI. Among the 10 percent of shoulders (128 total) that were symptomatic, 98 percent (126 total) also displayed abnormalities.

The study initially suggested full-thickness tears were more common in symptomatic shoulders. However, after accounting for other factors identified in the MRIs, that difference disappeared. The prevalence of tendinopathy and partial-thickness tears was similar in both groups – those with pain and those without.

A Call for New Language

The authors contend that the widespread presence of these “abnormalities” means clinicians need to rethink how they discuss MRI findings with patients. They propose moving away from terms like “tear,” which implies a need for repair, and toward more neutral language such as “lesion,” “defect,” “fraying,” or “structural alteration.”

“While we refer to these findings as abnormalities, many likely represent normal age-related changes rather than clinically relevant structural changes,” the authors write. This shift in language, they believe, could reduce patient anxiety and the feeling that immediate intervention is required.

Two orthopedic surgeons from University of California, San Francisco, Edgar Garcia-Lopez and Brian Feeley, echoed this sentiment in an accompanying editorial, agreeing with the need for a more nuanced approach to interpreting and communicating MRI results.

What This Could Mean for Your Care

The surgeons suggest a “watch-and-wait” approach for shoulder pain not related to a specific injury. This would involve a period of rest and physical therapy to regain function, with an MRI considered only if there’s no meaningful improvement after a couple of months. They emphasize that treatment decisions should be based on a patient’s history, a clinical exam, and their functional limitations – not solely on what an MRI reveals.

The study is not intended to discourage the use of MRIs altogether, but to reinforce that the diagnosis and management of shoulder pain should be guided primarily by how the shoulder functions in daily life.

Frequently Asked Questions

What percentage of shoulders in the study showed abnormalities on MRI?

A very high percentage – 96 percent of asymptomatic shoulders and 98 percent of symptomatic shoulders showed abnormalities on MRI.

What do the authors suggest changing about how MRI results are communicated?

The authors suggest using more precise and less alarming language, such as “lesion” or “structural alteration,” instead of terms like “tear” that imply a need for repair.

What is the suggested first step for shoulder pain not caused by an injury?

The surgeons suggest trying a couple of months of rest or physical therapy to regain function before considering an MRI.

How might a shift in how we interpret and discuss MRI findings impact your approach to seeking care for shoulder pain?