JAMA Clinical Reviews From the JAMA Network: Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging
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Mar 28, 2026 Brian T. Feeley, UCSF shoulder surgeon and sports medicine researcher, and Thomas Ibounig, Finnish shoulder surgeon and rotator cuff MRI investigator, discuss MRI shoulder findings. They cover why imaging-driven diagnostics need scrutiny. They describe high prevalence of age-related MRI abnormalities and rising full-thickness tears with age. They debate report language, risks of overdiagnosis, and when to order MRI.
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Nearly Universal Shoulder MRI Abnormalities After Age 40
- MRI shoulder abnormalities are extremely common in adults over 40, appearing in 99% of participants.
- Thomas Ibounig found minor changes predominate in younger people while older participants show more severe pathology including tears.
Full Thickness Tears Are Common But Often Asymptomatic
- Full thickness rotator cuff tears are uncommon at 40 but occur in over 20% of people aged 70 and above.
- Thomas Ibounig emphasized that many individuals with full thickness tears are asymptomatic and unaware.
Rephrase MRI Reports To Reduce Patient Anxiety
- Reinterpret alarming MRI language when counseling patients; put findings into aging context rather than implying imminent failure.
- Brian T. Feeley suggests using comparative phrasing like 'consistent with age' to reduce unnecessary alarm.