Nearly all people aged over 40 show changes in shoulder MRI scans – weak link to shoulder problems

The results of the recent study were published in the JAMA Internal Medicine journal. According to the researchers, the results challenge the current approach that gives MRI a central role in the diagnosis of shoulder problems.  

“For a long time, shoulder problems have been linked to structural changes, which is why imaging has become a prominent examination method. If abnormalities are discovered, the patient is often referred directly for treatment,” says Thomas Ibounig, Doctoral Researcher, Specialist in Orthopedics and Traumatology. 

The study was conducted on 602 randomly selected 41–76-year-old Finnish individuals whose shoulders were clinically examined and given an MRI scan. Nearly 99% of the study subjects had at least one abnormal finding. Of this group, 25% showed a change in a tendon, 62% a partial tear and 11% a complete tear. 

The occurrence of these changes increases with age. The study, however, revealed that the occurrence was nearly the same in symptomatic (96%) and symptom-free (98%) shoulders. Even the complete tears were common in symptom-free study subjects: 78% were discovered in shoulders that had zero symptoms. 

“Changes in the rotator cuff are nearly unavoidable due to aging, and them showing up in MRI scans does not automatically indicate a disease or a need for treatment,” says Simo Taimela, Associate Professor and Head Researcher. 

 
Unnecessary imaging takes up resources from effective treatment 

According to Ibounig, MRI rarely contributes to finding the cause of shoulder problems, especially in situations where the onset of pain does not involve an injury, or the patient does not have clear functional issues. He says that it is important to pay attention to the terminology used: “The term ‘tear’ can cause undue alarm and lead to unnecessary treatment. Our study revealed that these tears are often simply a normal sign of aging.” 

Professor Teppo Järvinen from the University of Helsinki emphasizes the broader meaning of the results: “This study shows the importance of questioning existing practices. Nearly everyone has abnormal findings that do not give a convincing explanation for shoulder-related symptoms. At worst, a patient may be misdiagnosed and referred for treatment that does not give them relief and could even do them harm.” 

Järvinen also brings up the use of resources: “Unnecessary imaging and treatment take up resources from effective treatment. Thus, imaging should only be ordered if the patient has been injured, they experience significant functional problems or there is a suspicion of a more serious cause.” 

The researchers also emphasize the role of patient communication. Neutral terms, such as fraying, degenerative change or aging-related change, are deemed to better reflect the true nature of the findings and prevent undue alarm and overtreatment. 

Link to the research article: Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging | JAMA Internal Medicine

FICEBO (Finnish Centre for Evidence-Based Orthopedics) is an internationally recognized academic research group active in the University of Helsinki and HUS. FICEBO is at the forefront of surgical research and evidence-based medicine in Finland.

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