Nearly all 40+ Finns show changes in shoulder MRI scans: study

Even symptom-free people aged over 40 show changes in MRI scans of the rotator cuff tendons, said Helsinki-Uusimaa Hospital District (HUS) in a press release on Tuesday referring to a recent population study conducted in Finland.

These findings are common but their link to shoulder problems is weak.

The results of the study were published in the JAMA Internal Medicine journal.

According to the researchers, the results challenge the current approach that gives MRI a central role in the diagnosis of shoulder problems.

“For a long time, shoulder problems have been linked to structural changes, which is why imaging has become a prominent examination method. If abnormalities are discovered, the patient is often referred directly for treatment,” said Thomas Ibounig, Doctoral Researcher, Specialist in Orthopedics and Traumatology.

The study was conducted on 602 randomly selected 41–76-year-old Finnish individuals whose shoulders were clinically examined and given an MRI scan.

Nearly 99% of the study subjects had at least one abnormal finding. Of this group, 25% showed a change in a tendon, 62% a partial tear and 11% a complete tear.

The occurrence of these changes increases with age.

The study, however, revealed that the occurrence was nearly the same in symptomatic (96%) and symptom-free (98%) shoulders.

Even the complete tears were common in symptom-free study subjects and 78% were discovered in shoulders that had zero symptoms.

“Changes in the rotator cuff are nearly unavoidable due to aging, and them showing up in MRI scans does not automatically indicate a disease or a need for treatment,” said Simo Taimela, Associate Professor and Head Researcher.

According to Ibounig, MRI rarely contributes to finding the cause of shoulder problems, especially in situations where the onset of pain does not involve an injury, or the patient does not have clear functional issues.

He said that it is important to pay attention to the terminology used.

“The term ‘tear’ can cause undue alarm and lead to unnecessary treatment. Our study revealed that these tears are often simply a normal sign of aging.”

Professor Teppo Järvinen of the University of Helsinki emphasized the broader meaning of the results.

“This study shows the importance of questioning existing practices. Nearly everyone has abnormal findings that do not give a convincing explanation for shoulder-related symptoms. At worst, a patient may be misdiagnosed and referred for treatment that does not give them relief and could even do them harm,” Järvinen said.

“Unnecessary imaging and treatment take up resources from effective treatment. Thus, imaging should only be ordered if the patient has been injured, they experience significant functional problems or there is a suspicion of a more serious cause,” Järvinen added.

The researchers also emphasized the role of patient communication.

Neutral terms, such as fraying, degenerative change or aging-related change, are deemed to better reflect the true nature of the findings and prevent undue alarm and overtreatment.