99% of People Over 40 Have Rotator Cuff Damage on MRI — Here's Why It Doesn't Matter

If you're over 40 and you've had a shoulder MRI, there's a 99% chance your report says something is wrong with your rotator cuff. Tendinopathy. Partial tear. Maybe even a full-thickness tear. That sounds terrifying. But a brand new study just scanned over 600 random people's shoulders — people with pain AND people without — and what they found completely changes how we should think about these results.

Hey everyone, Dr. Jeff Peng here. I'm a sports medicine doctor currently practicing in the SF Bay Area, and I see patients every week who walk in with an MRI report convinced their shoulder is destroyed. Today I'm going to show you why that report might not mean what you think it means.

The JAMA Study That Changes Everything

A study just published in JAMA Internal Medicine — one of the top medical journals in the world — and the headline number is staggering. Researchers scanned 602 random adults with high-strength 3-Tesla MRI. Not patients. Not people with shoulder problems. Just regular people from the general Finnish population, ages 41 to 76. And 99% of them had at least one rotator cuff abnormality. Only 7 people out of 602 had a completely normal rotator cuff. Seven.

Sixty-two percent had partial-thickness tears. That's nearly two out of every three people walking around with a partial tear in their rotator cuff, most of them with no idea. Eleven percent had full-thickness tears — a complete defect through the tendon. And the most commonly affected tendon was the supraspinatus. Ninety-eight percent of participants had an abnormality in that one tendon alone. Even in the youngest group — ages 41 to 44 — the vast majority already had changes on MRI.

Does Rotator Cuff Damage on MRI Actually Mean Anything?

If almost everyone has rotator cuff damage on MRI, does it even mean anything when YOUR MRI shows it? That's exactly what these researchers tested — and the answer is going to surprise you.

Rotator cuff abnormalities were found in 96% of pain-free shoulders and 98% of painful shoulders. Whether your shoulder hurts or not, you almost certainly have rotator cuff changes on MRI. The difference between the two groups was just 2%. Tendinopathy — same in both groups. Partial tears — same in both groups. The only finding that was slightly more common in painful shoulders was full-thickness tears, about 15% versus 7%. But even that small difference disappeared once they accounted for age, clinical exam findings, and other shoulder abnormalities on MRI.

Most Full-Thickness Tears Cause Zero Pain

This is the part that really drives it home. Out of all the full-thickness tears they found, 78% were in shoulders with zero pain. They also identified 26 people who had full-thickness tears in both shoulders. Of those 26 people, 17 had no symptoms on either side. So even the finding that sounds the scariest — a complete tear through your tendon — was painless the majority of the time.

Rotator Cuff "Tears" Are a Normal Part of Aging

So what do we call something that happens to virtually everyone as they age and doesn't cause symptoms in most people? We call it a normal part of aging. Your rotator cuff "tearing" is like your hair going gray or your skin getting wrinkles. It happens. It's not a disease. The researchers actually make this exact point in the paper — they argue the word "tear" is part of the problem. It sounds like something ripped. It sounds like something you need to fix. But for most people, what's 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's not an injury. That's biology.

What Should You Actually Do About Shoulder Pain?

If your shoulder pain came on gradually — not from a fall or a specific injury — an MRI probably shouldn't be your first step. This study shows that whatever it finds was almost certainly there before your pain started, and it'll still be there after your pain resolves. The authors point out that in people over 50, the chance of having a "normal" rotator cuff on MRI is basically zero. A positive MRI tells you almost nothing about why you're hurting.

Now, that doesn't mean rotator cuff tears never matter. A traumatic injury, sudden loss of strength, inability to lift your arm — that's a completely different clinical picture, and imaging makes sense in that context. But for the majority of people with gradual shoulder pain? The answer isn't surgery. It's rehab, movement, and time.

For patients who have tried conservative treatment without improvement, there are also advanced non-surgical options worth considering. Platelet-rich plasma (PRP) therapy uses your own blood to deliver concentrated growth factors directly to the injured tendon, promoting tissue repair. Shockwave therapy (ESWT) is another non-invasive treatment that uses acoustic waves to stimulate healing in damaged tendons — and a systematic review of 45 clinical trials found it to be highly effective for rotator cuff tendinopathy specifically. Both of these treatments can be excellent alternatives to surgery for patients with chronic rotator cuff pain that hasn't responded to physical therapy alone.

The Bottom Line

If you've been told you have a rotator cuff tear and you've been stressing about it, now you know — in most cases, it's a normal part of aging, not something that's broken and needs fixing. Don't let your MRI report dictate how you feel. Use your symptoms as a guide, focus on rehab and staying active, and know that the vast majority of rotator cuff findings on MRI are completely painless and do not require surgery.

If you're dealing with shoulder pain and want to explore non-surgical treatment options, schedule a consultation with Dr. Peng to discuss the best approach for your specific condition.