- Jeffrey Peng MD
- 5 days ago
- 4 min read
By Dr. Jeffrey Peng, MD · Published March 8, 2025 · 6 min read
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If you are over 40 and have had a shoulder MRI, there is a very good chance your report mentions something about your rotator cuff — tendinopathy, a partial tear, maybe even a full-thickness tear. Those words sound alarming. But a landmark study published in JAMA Internal Medicine is challenging everything we thought we knew about what these findings actually mean. The researchers scanned over 600 people from the general population and discovered that nearly everyone had rotator cuff changes on MRI — whether their shoulder hurt or not.
In my practice, I see patients every week who walk in with an MRI report convinced their shoulder is falling apart. This study provides powerful reassurance and an important lesson: your MRI report might not tell the whole story.
How Common Are Rotator Cuff Abnormalities on MRI?
The numbers from this study are striking. Researchers performed high-strength 3-Tesla MRI on 602 adults from the general Finnish population, ages 41 to 76. These were not patients seeking care for shoulder problems — they were randomly selected individuals from the community. Out of 602 people, only 7 had a completely normal rotator cuff. That means 99% had at least one abnormality (Ibounig et al., 2026).
Breaking it down further, 62% had partial-thickness tears — nearly two out of every three people walking around with a partial tear, most with no idea. Eleven percent had full-thickness tears, meaning a complete defect through the tendon. The most commonly affected tendon was the supraspinatus, with 98% of participants showing an abnormality in that tendon alone. Even in the youngest age group (41 to 44), the vast majority already had changes visible on MRI.
Do Rotator Cuff Findings on MRI Correlate with Shoulder Pain?
This is the critical question, and the answer is revealing. Rotator cuff abnormalities were found in 96% of pain-free shoulders and 98% of painful shoulders. The difference between the two groups was just 2%. Tendinopathy rates were the same whether or not the shoulder was symptomatic. Partial tear rates were the same. The only finding that was slightly more common in painful shoulders was full-thickness tears — about 15% versus 7%.
However, even that small difference in full-thickness tear prevalence disappeared once the researchers adjusted for age, clinical examination findings, and other shoulder abnormalities on MRI. In other words, a full-thickness tear on its own did not independently predict whether someone had pain.
Perhaps the most powerful finding: out of all the full-thickness tears identified, 78% were in shoulders with zero pain. The researchers also found 26 people who had full-thickness tears in both shoulders. Of those 26, 17 had no symptoms on either side. The finding that sounds the scariest — a complete tear through your tendon — was painless the majority of the time.
Is a Rotator Cuff "Tear" Really an Injury?
When something happens to virtually everyone as they age and does not cause symptoms in most people, we should call it what it is: a normal part of aging. Your rotator cuff changing over time is much like your hair going gray or your skin developing wrinkles. It happens. It is not a disease.
The researchers make this exact point in their paper. They argue that the word "tear" is part of the problem. It sounds like something ripped — like something that needs to be fixed. But for most people, what is actually happening is gradual fraying and wear. No one under 45 in this study had a full-thickness tear. By age 70, 28% did. That is not an acute injury. That is biology.
When Does a Shoulder MRI Actually Matter?
If your shoulder pain came on gradually — not from a fall or a specific injury — an MRI probably should not be your first step. This study demonstrates that whatever it finds was almost certainly there before your pain started, and it will likely still be there after your pain resolves. The authors note that in people over 50, the chance of having a "normal" rotator cuff on MRI is essentially zero. A positive MRI in that population tells you almost nothing about why you are hurting.
That said, rotator cuff tears are not always irrelevant. A traumatic injury with sudden loss of strength, inability to lift the arm, or acute weakness after a fall — that is a completely different clinical picture, and imaging makes sense in that context. In my practice, the clinical history and physical examination remain far more valuable than the MRI report for guiding treatment decisions.
What Should You Do About Gradual Shoulder Pain?
For the majority of people with gradual-onset shoulder pain, the answer is not surgery. It is rehabilitation, movement, and time. A structured physical therapy program focusing on rotator cuff strengthening and scapular stabilization is the first-line treatment supported by the evidence.
If you have been told you have a rotator cuff tear and you have been stressed about it, this research should be reassuring. In most cases, what the MRI shows is a normal part of aging — not something that is broken and needs fixing. The key is working with a clinician who understands the difference between an incidental finding and a clinically significant problem. If you are looking for guidance on next steps, consider scheduling a consultation to discuss your specific situation.
References
1. Ibounig T, Järvinen TLN, Raatikainen S, et al. Incidental rotator cuff abnormalities on magnetic resonance imaging. JAMA Intern Med. Published online February 16, 2026. doi:10.1001/jamainternmed.2025.7903
Medical Disclaimer: This content is for educational purposes only and does not substitute for the medical advice of a physician. Always consult your healthcare provider before beginning any new treatment program. The information presented reflects the opinion of Dr. Jeffrey Peng and does not represent the views of his employers or affiliated hospital systems.