MRI scans reveal normal age-related changes in people’s shoulders
After 40, we can all have broken shoulders. But that doesn’t mean anything is wrong.
In a study of hundreds of people, MRI images showed that almost all people scanned had frayed, torn or abnormal rotator cuff tendonsresearchers report on February 16 in JAMA Internal Medicine. However, these abnormalities did not automatically mean problems or the need for surgery – they appeared in people with or without symptoms.
A take-home message is that MRIs aren’t very helpful in diagnosing shoulder pain, says Brian Feeley, an orthopedic surgeon at the University of California, San Francisco, who was not involved in the work. Instead, the imaging test reveals a broader view of aging: When it comes to the structure of our skeleton and all the tendons and tissues that support it, he says, our bodies look different as we age. “And that’s not necessarily a bad thing.”
The rotator cuff is the group of muscles and tendons surrounding each shoulder joint. This helps control where your arm is in space, says Feeley. It is also a common source of shoulder pain. Surgery can repair rotator cuff tears and the number of these operations tends to increase. From 2007 to 2016, the rate of these repairs in the United States has increased by more than 1 percent each yearresearchers reported in 2021. This may be due, in part, to more patients undergo MRIwrote Feeley in a commentary accompanying the new work. Hundreds of thousands of patients undergo this repair each year.
Previous studies have suggested that shoulder abnormalities visible on MRI are not always accompanied by symptoms. The new study offers definitive proof that such abnormalities are a normal part of aging, Feeley says.
Researchers scanned the shoulders of Finnish adults aged 41 to 76 and noted shoulder pain or other problems. While 110 of the 602 participants experienced such symptoms, all but seven had a rotator cuff abnormality, such as a partial or complete tear of the tendon. This “means that the mere presence of an abnormality has limited diagnostic value,” writes Thomas Ibounig, study co-author and shoulder and elbow surgeon at Helsinki University Hospital.
The new work doesn’t say shoulder MRIs are useless. When surgery is necessary, Feeley uses technology to plan where he will anchor the torn tendon to the bone. But when it comes to diagnosis, he sticks to the basics, like listening to patients describe their symptoms, taking a history and doing a physical exam. “Old-fashioned medicine,” Feeley says.
