99% of Adults Over 40 Have Shoulder 'Abnormalities' on an MRI, Study Finds

Up to a third of people worldwide have shoulder pain; it's one of the most common musculoskeletal complaints. But medical imaging might not reveal the problem -- in fact, it could even cloud it. From a report: In a study published in JAMA Internal Medicine this week, 99 percent of adults over 40 were found to have at least one abnormality in a rotator cuff on magnetic resonance imaging (MRI). The rotator cuff is the group of muscles and tendons in a shoulder joint that keeps the upper arm bone securely in the shoulder socket -- and is often blamed for pain and other symptoms.

The trouble is, the vast majority of the people in the study had no problems with their shoulders. The finding calls into question the growing use of MRIs to try to diagnose shoulder pain -- and, in turn, the growing problem of overtreatment of rotator cuff (RC) abnormalities, which includes partial- and full-thickness tears as well as signs of tendinopathy (tendon swelling and thickening). "While we cannot dismiss the possibility that some RC tears may contribute to shoulder symptoms, our findings indicate that we are currently unable to distinguish clinically meaningful MRI abnormalities from incidental findings," the study authors concluded.

Forgive me for being pedantic, but

[Rosco P. Coltrane]

If 99% of people have something abnormal, isn't it in fact the norm?

Re:Forgive me for being pedantic, but

[groobly]

Not necessarily. Suppose there are 10 different checkboxes for "normal." Then if everyone has one item abnormal, randomly distributed among items, then 90% of people are 90% normal, 90% of people have something abnormal, and for each criterion, 90% of people are completely normal.

Re:Forgive me for being pedantic, but

[Rosco P. Coltrane]

I should have written "90% of people have the SAME abnormal thing". I've been thoroughly out-pedanted. Well done Sir :)

Re:

[sacrilicious]

:) I'm sure he puts on his pedants one leg at a time just like we do.

Re:

[AmiMoJo]

Well it depends. There are many different religions that believe in the supernatural. All of them are wrong, and people who believe in little green men with anal probes are crazy. But enough people believe in a supernatural creator, even if it's many different ones, with a diverse set of characteristics, that it's considered normal.

Which is to say that normal is often mostly whatever makes people comfortable.

Re:

[EvilSS]

That's exactly what the study is trying to say.

Re:

[pngwen]

Yes! Clearly, this story was written by the 1% who wishes everyone's shoulders were like theirs.

Re:

[chmod a+x mojo]

To be even more pedantic, no.

If something is commonly done in the modern environment is damaging joints on the majority of people, it isn't baseline norm. Baseline "norm" is the structure before any injuries or changes occur.

It doesn't mean just because most / almost all of those injuries happen in a lifetime that it's the "normal" state. It means we fucked up somewhere, and have to find and change environmental design flaws to stop injuring people. Just like Carpal Tunnel / RSI injuries from doing repeated

Too many archers

[will4]

A google or two will give an interesting read about how they identified archers in ancient mass battle grave sites by structural changes in their shoulder bones due to repeated specialized stress of drawing a bow.

That is not what that means

[drinkypoo]

The trouble is, the vast majority of the people in the study had no problems with their shoulders

Are you sure they don't have limited mobility? Because this study, like so many other worthless studies, depends on self-reporting of shoulder problems. People can have problems they have so effectively learned to live with they don't even recognize that they are problems. If I had my head totally up my ass I wouldn't notice that I cannot sleep as long on my right side as I can on my left because my shoulder gets tired. Now look around you, what percentage of the population would you estimate suffers from cranial-rectal inversion?

Re:

[dskoll]

Yeah, shoulders tend to give a lot of trouble. The shoulder joint has the widest range of motion of any joint in the body, and its tendons are not well-served by blood vessels, so healing tends to take a long time. I had adhesive capsulitis (aka "frozen shoulder") starting in the beginning of 2023 and it was miserable. It took about 18 months to resolve and even now I have slightly limited mobility in my left shoulder, though it doesn't affect my daily activities.

Re:

[SouthSeb]

I too had adhesive capsulitis in both shoulders, one right after the other. One of them took more than 2 years to stop hurting, and the healing is so slow that I really can't say when it occurred. I just vaguely remember putting some clothes one day and suddenly noticing "hey! my shoulder doesn't hurt anymore."

Re:

[EvilSS]

If you took your head out of your ass you could read the study and see that they performed a clinical exam along with the MRI and accounted for RC finding in the clinical exams.

Re:

[drinkypoo]

Fair. Nearly-worthless article, not worthless study.

Article isn't worthless because it contains a link to the study.

Re:

[phantomfive]

The trouble is the reporting in Ars Technica. Here is the paper [jamanetwork.com]. Here is what a tear looks like in the rotator cuff [complete-physio.co.uk]. Some of the people had tendinitis, which is (obviously) less serious than a torn tendon. By "MRI abnormality" they mean most people had a torn tendon. By "problem" they meant symptomatic (pain, severely limited mobility). Surgery might make some of these problems worse, since you are literally cutting the person in surgery.

obviously

[groobly]

You don't get an MRI unless you have a problem. 99% of the people who got MRI because they had a problem were shown to have a problem visible on MRI.

This is nothing more than yet another propaganda attempt to save money on medical tests.

Re:obviously

[alvinrod]

You're missing what the article is about. What you say is true, but it's also claiming that when people without problems are given an MRI the results make it appear as though they do have a problem. If a person did have a problem they'd need an MRI anyway to determine where the problem is and how to fix it. Unless the surgeons are going to replace the entire arm, how would they know what needs to be operated on without the MRI? This only prevents needless surgeries for those who had an MRI for some other reason but had their doctor point out something that looks like a shoulder problem.

This seems like a good start for a longitudinal study. Do these people develop shoulder problems later and the MRI is just catching in very early? Is there some other factor that can predict those who will later have shoulder problems vs. those who won't? This study may not tell us much by itself, but it tells us what questions we ought to be asking to explain the results. The first step is to replicate the results from this study to ensure it wasn't due to some fluke or other factor that wasn't controlled for and from there to develop other studies to help us understand what's happening better. I think that makes it a rather useful study.

Re:

[Retired Chemist]

Actually, at least in the US this it is not true anymore that you only get an MRI if you have a problem. There are all these people selling "whole body MRIs" with the claim that they will find your problems (particularly but not limited to cancer) before you have any symptoms. Since virtually everyone has something or several things unusual show up (see above), there has been a large increase in people seeking care for what mostly turns out to be nothing significant.

Re:obviously

[Tim Doran]

They didn't start with people who had sought MRIs. They started with a huge cohort of people who have volunteered to have their health studied (since 2000). People from this cohort were randomly selected and invited to join the study.

Re:

[dargaud]

My guess (and that's all it is) is that me descended from apes who use their shoulders to climb trees. Since few people climb things nowadays (except for rock climbers), shoulders are not meant to only carry a fork to your mouth to turn the wheel of the car, so potential problems are not selected against.

Re:obviously

[EvilSS]

This was the selection criteria for the study:

In 2022, the Health 2000 database was reviewed to identify all individuals eligible for the FIMAGE study. To be eligible, participants had to meet the following criteria: (1) prior participation in the Health 2000 survey, (2) valid consent for the Health 2000 follow-up, (3) ability to communicate in Finnish or Swedish, (4) ambulatory status, (5) maximum age of 75 years at the time of sampling, and (6) residence within the catchment areas of the 5 university hospitals, ensuring reasonable access to a 3-Tesla (3T) MRI facility.

You will note that "has shoulder problem" is not one of the criteria.

The study population:

A total of 602 participants (median age, 58 [range, 41-76] years) underwent clinical shoulder examination and bilateral shoulder MRI and were included in the study. Of these, 313 (52.0%) were females and 289 (48.0%) were males. At the time of the research visit, 110 participants (18%) reported current shoulder symptoms. Among the asymptomatic group, 294 participants (60%) reported a previous history of shoulder symptoms

So 18% reported current shoulder symptoms, and of those who didn't, 40% reported having no history of shoulder symptoms.

Re:

[phantomfive]

Nowdays people are getting MRIs even without symptoms, just for a checkup. https://prenuvo.com/ [prenuvo.com]

can't wait to hear about this from everyone

[snowshovelboy]

I have a maga type friend who swears the spike protein in the covid vaccine damaged his shoulder joint. This story is going to take off like wildfire for the most annoying reasons.

Re:

[93 Escort Wagon]

MAGA types (I know a few, plus my mom is one) specifically blame the "spike protein" for all sorts of random ailments. And, what's doubly weird is - it's only if it was associated with the vaccine, not with the Covid-19 virus itself.

My mom has been sick with actual Covid a couple times... but, when she's trying to pin the blame for some ailment or other on something, her go-to is the vaccine's spike protein "floating around in her blood".

Re:

[mrfiat]

I am not a MAGA type. I suffered long bicep tendon pain for 2 years in both shoulders after my Covid vaccines... My orthopedic surgeon said the vaccines inflamed the tendons and never get shots in my shoulders again. He said he has seen it before. I tried everything, PT, MRIs, ultrasound guided steroid shots, and finally my surgeon at the time just gave up and said there was nothing he could do. After two years the extreme pain finally went away on its own. I got a flu shot at that point and that infl

Re:

[aRTeeNLCH]

I got myself a non healing distaal biceps tendinopathy doing pull ups. This was in 2023. Eventually the doctor told me any training was fine and even good, as long as it wouldn't hurt after. BTW resting didn't help at all. I pushed it a lot, but wouldn't even get muscle aches even when pushing the limits. It still took more than a year, closer to two. Note that contrary to you, I didn't have great pain, I merely had a strong feeling of discomfort when holding something at a right angle -think standing with

Confirmation bias

[CAIMLAS]

I actually do have shoulder problems, from a combination of a motorcycle accident and regular jujitsu. They told me I needed to reconstruct the shoulder. I put it off, and started combat sports instead... my shoulder no longer hurts (generally) and I've got (mostly) full range of motion and strength.

In contrast, I suffered with lower back pain for years, and it got to the point where I was immobilized. MRI scans showed nothing.

The problem in most cases is usually muscular-skeletal interaction. Not the bones

Re:

[kackle]

Look into "proliferation therapy" which treats weak ligaments. It used to be only through regenerating injections, but now near me focused ultrasound is a possibility.

Re:

[whoever57]

Look into "proliferation therapy" which treats weak ligaments. It used to be only through regenerating injections, but now near me focused ultrasound is a possibility.

My dog is undergoing both a series of injections and focused ultrasound for her arthritis (she's less than a year old).

Re:

[kackle]

I read the books of the men who studied and advanced "prolotherapy" in more recent times (Hackett, Hemwall). One of them claimed that most back surgeries were unnecessary and could have been replaced by prolotherapy.

Poor pooch; tell her "Woof-woof ruff ruff woof" for encouragement. She'll know what it means.

Re:

[CAIMLAS]

Thanks for that.

I know a lot of older guys my age who've had good luck with bp157 but it's got a pretty steep price. This seems perhaps cheaper.

Re:

[kackle]

I hadn't heard of BP(C)-157. I suspect all of these methods are the "same thing": A way to intentionally cause inflammation to certain tissues to encourage them to rebuild. Hippocrates supposedly used hot needles, for example. And I've even read of electricity being an (untried?) possibility, which doesn't surprise me--perhaps that mechanism is solely responsible for the all-but-dismissed successes of the electrotherapeutic field about a century ago.

Every body is different

[flyingfsck]

I have some internal organs positioned in the wrong place and a major artery in my neck is missing. The more you look, the more such differences you will find.

same as spinal discs

[cellocgw]

For decades the surgeons have checked out people with back pain, found slipped or decaying discs, an declared that the problem. Then they do horrific things like vertebral fusions.
Problem was/is that there's no database of Xrays/CT/NMR scans of people *without* back pain to see how many have bad discs

Re:

[nealric]

Knees too. Really all joints. It turns out that things like cartilage tears and other "abnormalities" are not great indications of dysfunction or pain. I can understand how we got here. It seems obvious when tissue looks damaged in an image that something must be wrong- especially when surgeons can go back and "fix' the tear so it looks right again in an MRI. Procedures are also cash cows (especially ones that can be done en masse by outpatient surgery centers), so there is a huge built-in incentive to deal

MRI won't tell you when it's you, not the shoulder

[TigerPlish]

MRI won't tell you your ever-present shoulder and back and neck pains are caused by forever assuming a physical defensive posture, itself coming from old PTSD.

That problem lies in the mind, not the body.

Yeah wonder why

[iluvcrap2000]

Carrying heavy ass backpacks when we were kids.

Re:

[tlhIngan]

Yeah, that's what I thought too - most kids do not wear backpacks properly (how many times have you seen a backpack worn only over one shoulder?).

And with textbooks weighing what they do and kids having to bring them back and forth for homework, it's no wonder they have shoulder and likely the beginnings of back problems.

As a baseball fan...

[edwdig]

The rule of thumb in baseball is that if you take an MRI of a pitcher's shoulder, you'll find something wrong.

This is why they don't jump to surgery right away and generally just try to rehab if at all possible. It's got to get really bad before you even think of fixing it.

We're also really bad a fixing shoulders. The odds of you coming back at full strength are a lot lower than with most surgeries.

So yeah, none of this is really news. Everyone's shoulder is a little messed up, and its usually not worth try

Re:

[King_TJ]

I don't even follow baseball real closely, but I feel like I'm in agreement. I know I injured my right shoulder a few years ago. It was one of those dumb things; stretched as far behind my back as I could with that arm to scratch an itch on my back while in the shower, and next thing I knew? I had really bad shoulder pain just trying to lift my arm anywhere near my neck or head.

I figured it was going to go away on its own but for months, it didn't. I was just about to resign myself to going to a doctor and

MRIs are very good tools

[LunaticTippy]

They add hundreds if not thousands of dollars to the bill, they require a special physical trip to a facility, and they can be used to justify other tests, surgical interventions, and specialist visits. They are nearly entirely useless diagnostically, but they are wonderfully effective tools to extract money from society.

Not new information, read about this years ago

[magzteel]

I have a full-thickness partial-width large rotator cuff tear, confirmed by MRI. At one point I was in a lot of pain and had difficulty getting dressed so I went to an orthopedist. After the MRI he suggested surgery. I researched rotator cuff issues and found out that

1) Almost everybody above a certain age would have some kind of tears show up on an MRI, with little or no symptoms
2) Rotator cuff surgery can take months to heal, with pain and very limited motion in the affected arm
3) The prognosis for man

Symptoms

[ledow]

The more you look, the more you'll find "wrong". It doesn't mean there's actually anything wrong, because we just don't look at healthy people and then leave something that looks "wrong" untreated.

It's why the House-style diagnostics of rare conditions is so complex and specialist, because everywhere you look you'll find something wrong and you have no idea if that's a symptom, a quirk, or nothing at all.

It's part of why cancer diagnoses went through the roof. Because we started routinely screening for ca

dx by MRI is inappropriate for many condititions

[justsomeguy05]

MRI's are great for some things, but orthopedists frequently use x-rays & MRI's to diagnose conditions that are completely unrelated to the patients' symptoms. Many/most are clueless about certain types of soft tissue conditions that are not well visualized by MRI. They also suggest steroid injections (which 80-90% of the time are not warranted, especially "diagnostic" ones), or refer to Physical therapy (which can be great for SOME patients, but will worsen existing inflammation of many soft tissue c