Shoulder MRI's useless?

Another hard hitting take home message regarding MRI's. Originally they were thought to be the "holy grail". Conceptually, if we could "just see what is going on" it would make a difference (in treatment choices, outcome, etc). Well over the last decade there has been more scrutiny regarding the relevance (and usefulness) of MRI findings. We already know some patients with "bad" injuries do fine conservatively,  and other with seemingly minor injuries have chronic pain and poor outcomes. Right away that paints a picture that suggests an MRI finding might not be that important in an outcome.

Enter this study from 2026 where in Finland they looked at a sample of over 600 people aged 41 to 76 years of age. They were asked if they had any shoulder symptoms and classified as "symptomatic" or "a-symptomatic". MRI's were performed on both shoulders of each person (right and left sides). The results? An astounding 98.7% (just read that as 99%) had abnormal findings! Abnormalities increased with age, but there were no differences between male and female. Rotator cuff abnormalities were found in 96% of A-Symptomatic shoulder, and 98% in symptomatic shoulders. So the MRI's of patient's with "good shoulders" had essentially the same image findings as those with "bad", or painful shoulders.

In the authors conclusion they said "These findings suggest that RC abnormalities often represent normal age-related changes rather than disease and call into question the clinical value of routine imaging for atraumatic shoulder pain".

What does that mean for you? In our opinion it suggests MRI's are not helpful (unless, maybe if there was a trauma that started the pain) and may lead to creating fear in a patient, and/or lead a patient to believe they need a surgical intervention when they may not. The point is you do not necessarily "need" a rotator cuff surgery just because you have a rotator cuff tear. Most insurers will make you try PT first, but some may not and surgery may be suggested early on because of the MRIfindings. Find a good PT and try conservative care first. Also, don't let the results of your imaging mess with your mind, or your sway your beliefs regarding whether you will have a good or bad outcomes. Turns out almost everyone over 40 has some rotator cuff pathology if you go and look for it.