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Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging
Thomas Ibounig1,2, Teppo L N Järvinen1,2, Saara Raatikainen1,2
1Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland.
JAMA Internal Medicine
|February 16, 2026
Summary
Rotator cuff (RC) abnormalities are nearly universal in adults over 40, often representing normal aging, not disease. Imaging findings show poor correlation with shoulder pain, questioning its routine use for atraumatic shoulder pain.
Area of Science:
- Musculoskeletal imaging
- Orthopedic research
- Population health studies
Background:
- Shoulder pain is a common complaint, frequently linked to rotator cuff (RC) abnormalities.
- Diagnostic imaging is widely used, yet the connection between RC abnormalities and shoulder symptoms is unclear.
Purpose of the Study:
- To determine the prevalence of RC abnormalities in a general population.
- To assess the association between RC abnormalities and shoulder symptoms.
Main Methods:
- Population-based cross-sectional study in Finland.
- Included 602 adults aged 41-76 years with clinical assessment and shoulder MRI.
- Classified RC tendon status (normal, tendinopathy, partial-thickness tear, full-thickness tear) and shoulder symptoms.
Main Results:
- RC abnormalities were found in 98.7% of participants, increasing with age.
- Abnormalities were present in 96% of asymptomatic and 98% of symptomatic shoulders.
- Only full-thickness tears showed a trend toward higher prevalence in symptomatic shoulders, but this was not statistically significant after adjustment.
Conclusions:
- Rotator cuff abnormalities are nearly universal after age 40 and often represent age-related changes.
- The poor concordance between imaging findings and symptoms questions the clinical utility of routine imaging for atraumatic shoulder pain.
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