If you have ever had a shoulder scan and been told there is a tear, a partial tear, or tendinopathy in your rotator cuff, you are not alone. And there is a very good chance that finding has nothing to do with your pain.

A large population-based study published in JAMA Internal Medicine (Ibounig et al., 2026) scanned the shoulders of 602 adults aged 41 to 76 using high-resolution MRI. Every participant had both shoulders imaged, regardless of whether they had pain or not. The results are striking.

What the study found

99% of all participants had some form of rotator cuff abnormality on MRI. That is nearly every single person in the study.

When the researchers compared shoulders that hurt with shoulders that did not, the difference was almost meaningless. 96% of pain-free shoulders showed abnormalities. 98% of painful shoulders did. A 2% gap.

Even full-thickness rotator cuff tears, the kind that sound most alarming on a report, were predominantly found in shoulders with no symptoms at all. 78% of all full-thickness tears in the study were in people who had zero shoulder pain on that side.

Only 1% of all shoulders had completely normal-looking tendons on MRI.

What does this actually mean?

It means that the things showing up on your shoulder scan are almost certainly age-related changes. The lead researcher described rotator cuff changes after 40 as being “almost as expected as grey hair.” They are part of being a human who has used their shoulders for a few decades. They are not disease. They are not damage. They are wear.

The problem is that when someone is in pain and a scan shows a tear, it is very easy to assume the tear is the cause. In many cases, it is not. The tear was likely there before the pain started and will still be there after the pain resolves.

The over-imaging problem

Routine imaging for atraumatic shoulder pain (pain that came on gradually, without a fall or impact) is one of the most common drivers of unnecessary anxiety and unnecessary intervention. A scan picks up an “abnormality,” that finding gets labelled as the problem, and the patient is steered towards a surgical consultation when what they actually needed was a proper clinical assessment and a structured rehab programme.

There are absolutely times when imaging is appropriate. If there has been a significant trauma, if there is sudden loss of strength, if symptoms are not improving with appropriate conservative care, imaging helps guide decisions. But for the majority of gradual-onset shoulder pain, a thorough hands-on assessment tells us more than the scan does.

What I do in practice

I recently completed Jared Powell’s in person shoulder workshop, and his approach reflects exactly this evidence: assess thoroughly, treat the person and their function, and let the scan inform rather than dictate.

When someone comes in with shoulder pain, the assessment is everything. I want to know what movements provoke symptoms, what loads are tolerable, how the shoulder behaves through the day, and what the functional picture looks like. That gives me far more useful information than an MRI report listing incidental findings.

From there, treatment usually involves a combination of manual therapy to address any joint or soft tissue restrictions, and a progressive loading programme. Shoulders respond well to graded strengthening. The rotator cuff is a group of muscles, and muscles get stronger when you load them appropriately.

For patients who already have a scan and are worried about what it showed, a big part of the conversation is reassurance grounded in evidence. This study is a helpful one to point to. If 96% of pain-free shoulders look abnormal on MRI, then your scan findings are almost certainly not the whole story.

The takeaway

If your shoulder hurts, get it assessed properly. If you have already had a scan that looked alarming, do not panic. The odds are high that most of what showed up is completely normal for your age.

And if you are considering surgery based on imaging alone, a second opinion and a trial of structured rehab is almost always worth trying first.

Reference: Ibounig T et al. Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging. JAMA Intern Med. 2026. doi:10.1001/jamainternmed.2025.7903

Dr Michael O’Doherty (Chiropractor 4220637H) | Chiropractic Moves, Paddington
📞 0404 717 488 | chiropracticmoves.com.au

Dr. Michael O'Doherty

Hi, I’m Michael; Chiropractor, Dad, science enthusiast, active weightlifter and keen sportsman. I work with busy and active people who are struggling with pain to find relief from their symptoms so that they can return to an active lifestyle, get through their work day and their workouts without having to pop a pill so that they can feel happier and healthier in their body.