Rotator cuff abnormalities on MRI: more the rule than the exception?

Rotator cuff abnormalities on MRI: more the rule than the exception?

A recent Finnish study in JAMA Internal Medicine (February 2026) raises questions about the value of MRI in atraumatic shoulder complaints.

Researchers performed 3T MRI scans of both shoulders in 602 participants aged 41–76 from a representative population cohort. The findings were striking:

In 98.7%, at least one rotator cuff abnormality was found.

62% had a partial tear, and 11% had a full-thickness tear.

The prevalence was almost the same in people with shoulder symptoms (98%) and without shoulder symptoms (96%).

Even the majority of full-thickness tears were asymptomatic.

The conclusion: many cuff abnormalities appear to be age-related changes rather than the actual cause of symptoms. Routine imaging in non-traumatic shoulder pain carries the risk of overdiagnosis and overtreatment.

This is in line with the Dutch NHG guideline on shoulder complaints, which also advises restraint with ultrasound during the first three months in cases of subacromial complaints.

In daily practice, however, I do notice that waiting three months before performing an ultrasound can sometimes feel long, and it is not always easy to explain to a patient who is in pain and looking for answers. The temptation — for both doctor and patient — to turn to imaging sooner is understandable. At the same time, this study shows that such a scan often raises more questions than it answers: in this age group, a detected “abnormality” is often simply a normal sign of ageing.

Good explanation, expectation management and a targeted focus on functional recovery therefore remain the cornerstone of care — even if that sometimes feels uncomfortable.

If an ultrasound of the shoulder is necessary, this can be performed at the HAP.GENT practice. Referral to a radiologist is not required as a first step.

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