Shoulder Study Findings

In a recent study that analyzed 1,204 shoulders, it was found that 1,076 (90 percent) were asymptomatic while 128 (10 percent) were symptomatic. Among the asymptomatic shoulders, a striking 96 percent exhibited rotator cuff (RC) abnormalities, which translates to 1,039 out of the 1,076. On the other hand, 98 percent (126 out of 128) of the symptomatic shoulders also showed abnormalities.

The occurrence of tendinopathy and partial-thickness tears was quite similar across both symptomatic and asymptomatic shoulders. Initially, it appeared that full-thickness tears were more prevalent in the symptomatic group. However, after adjusting for various factors, including additional abnormalities detected in MRIs, this difference diminished.

Discussion

The authors suggest that these findings should prompt healthcare providers to reassess how MRI results are interpreted—not only in their application but also in the communication with patients. They emphasize that the term “abnormalities” is common, even normal, and that using terms suggesting a need for intervention, like “tear,” should be avoided.

“While we label these findings as abnormalities, many are likely just normal changes associated with aging rather than significant structural issues,” the authors state. “Utilizing more accurate and neutral terminology—like lesion, defect, fraying, or degeneration—may reduce anxiety for patients and lessen the perceived need for corrective actions, steering clear of language that implies trauma or repair is necessary.”

In an accompanying editorial, orthopedic surgeons from the University of California, San Francisco, Edgar Garcia-Lopez and Brian Feeley, support the suggested shift in terminology. They highlight the importance of contextualizing MRI results for patients.

They further discuss the crucial question of when MRIs should be utilized for shoulder pain. For cases not linked to injury, they recommend starting with a period of observation, possibly accompanied by rest or physical therapy, to gauge function recovery. If there isn’t significant progress, then an MRI might be justified. Nonetheless, they emphasize that treatment decisions should hinge on the patient’s history, clinical evaluations, and functional capabilities, rather than solely relying on imaging outcomes.

“These study findings aren’t meant to discourage appropriate MRI use,” the surgeons clarify, “but rather to emphasize that diagnosing and managing shoulder pain needs to focus primarily on the functional limitations.”