Our Mission

What Does This Study Mean For You? 

Author: Dr. Stephen Chaney

Your shoulder is painful. It interferes with your range of motion. It’s affecting your workouts and your daily activities. And it seems like the pain has hung on for far too long.

When you go to your physician, they suggest you get an MRI to see if PT (physical therapy) is sufficient or whether you need surgery to repair or replace portions of your shoulder.

This is a consequential decision. Let me share some statistics to illustrate why:

• Around 31% of US adults experience shoulder pain at any given time. The prevalence of shoulder pain is highest between ages 45 and 64 and remains high past age 65.

• MRI imaging is recommended by 50% of general practitioners as part of the initial evaluation of shoulder pain. It is considered essential by 82% of general practitioners and 56% of specialists.

The MRI imaging results often lead to a recommendation for surgery. But shoulder surgery is much more complicated than hip or knee replacement surgery.

• Because our shoulders move in many directions, they are packed with a complex of tightly packed muscles and tendons. They need to be protected or reattached, depending on the kind of surgery.

• Major nerves pass right next to the surgical zone, increasing the risk of nerve damage or numbness.

Because of this complexity, recovery times rotator cuff replacements are much longer and success rates lower than for knee or hip replacements.

• Recovery time is 6-12 months for rotator cuff replacement compared to 6-12 weeks for hip replacement and 3-6 months for knee replacement.

• The success rate for rotator cuff replacement surgery is 85-95% for small tears compared to 90-95% for knee replacement surgery and 95+% for hip replacement surgery.

And finally, there is the cost.

• Shoulder surgery can cost individual patients up to $40,000.

• Shoulder surgery costs the United States healthcare system around $12 billion a year.

That cost represents a burden to a healthcare system that is struggling to remain solvent. So, it is worthwhile asking whether that is a necessary cost.

Several small studies have suggested that the rotator cuff abnormalities detected by MRI are a normal part of aging rather than indicating the need for surgery unless there are additional indications that surgery is needed.

So, the authors of this study (T Ibouing et al, JAMA Internal Medicine, 186: 406-414, 2026) designed a large study to test the hypothesis that abnormal shoulder MRI readings were an indication of aging rather than an indication for surgical intervention.

How Was This Study Done?

The study drew participants from the Finnish Health 2000 Survey which enrolled 9922 individuals 18 and older in 2000 and has followed them continuously ever since.

In 2022, the Health 2000 database was reviewed to identify individuals who:

• Had given consent for follow-up studies.
• Had a maximum age of 75.
• Did not have previous shoulder replacement surgery.

These individuals were invited to participate in the Finnish Imaging Study (FIMAGE). A total of 602 participants enrolled in the study. The average age of the participants was 58 (range = 41-76) with 52% females and 48% males.

Each of the participants was asked if they had experienced shoulder symptoms lasting more than 24 hours during the past week and whether the symptoms were persistent or intermittent. They were also asked whether they had experienced previous incidents of shoulder pain.

This was followed by clinical evaluation of shoulder pain and disability by experienced shoulder surgeons.

Finally, each participant underwent bilateral MRI imaging to detect rotator cuff abnormalities, and the abnormalities were classified according to severity as follows:

• Tendinopathy – minor deformities of one the tendons attached to the rotator cuff.

• PTT – A fluid-filled defect of the tendon tissue extending to either surface of the rotator cuff or the tendon insertion point.

• FTT (most severe) – A fluid-filled defect of the tendon tissue extending to both surfaces of the rotator cuff.

Don’t get hung up on the definitions. That is a terminology only an anatomist could love. You just need to remember that tendinopathy was the least severe classification and FTT was the most severe.

Do You Need An MRI For Shoulder Pain?

The results were as follows:

• MRI imaging detected rotator cuff abnormalities in 98.7% of the participants. Of these:

• • 25% had tendinopathy (mild abnormalities).

• • 62% had PTTs (moderate abnormalities).

• • 11% had FTTs (significant abnormalities)

• The prevalence of abnormalities was similar in men and women.

• Rotator cuff abnormalities showed age-related progression, with milder findings in younger participants and more advanced structural damage in older participants.

Of the participants in this study, 81.7% were asymptomatic and 18.7% reported symptoms of shoulder pain or disability in the week prior to their MRI imaging.

• Rotator cuff abnormalities were observed in 96% of asymptomatic participants and 98% of symptomatic participants. This represented an absolute difference of 1.8%, which was not statistically significant.

When these data were broken down with respect to the severity of the abnormalities:

• There was no significant difference in the prevalence of tendinopathy or PTTs in asymptomatic and symptomatic shoulders of individuals with shoulder pain or dysfunction.

• FTTs (the most severe abnormalities) were more common in symptomatic shoulders (14.6%) than asymptomatic shoulders (6.5%).

• • However, this difference disappeared when it was corrected for positive clinical rotor cuff tests from the physical exam conducted prior to MRI imaging.

[Note: This means that rotator cuff abnormalities are best diagnosed by a physical evaluation by a specialist. MRI imaging did not add anything to the diagnosis.]

The authors concluded, “In this population-based study, rotator-cuff abnormalities [detected by MRI imaging] were nearly universal after age 40 years and showed poor correlation with shoulder symptoms. These findings suggest that rotator cuff abnormalities represent normal age-related changes rather than disease and call into question the clinical value of routine imaging for shoulder pain.”

My Wife’s Shoulder Pain Experience

A few years ago, my wife, Suzanne, had severe pain in her right shoulder. She could not lift her arm above her shoulder, and it was painful to even lift it to shoulder height.

Her doctor referred her to a shoulder specialist. To his credit, he didn’t order an MRI. But based on his clinical evaluation, he gave my wife two choices.

#1: She could get up to three corticosteroid shots to control inflammation. That treatment could not be used more than three times and came with a variety of side effects including:

• Weight gain.
• Mood changes.
• Sleep disruption.
• Suppressed immunity.
• Bone loss.

#2: Shoulder surgery, which was his recommended option (he was a surgeon).

He didn’t mention physical therapy.

My wife didn’t like either of these options, so she asked her chiropractor for a referral to a physical therapist. The first physical therapist she tried didn’t help her, so found another physical therapist. That physical therapist also didn’t help her, so she kept looking.

[As you might have guessed, my wife doesn’t give up easily. That’s her superpower.]

The third physical therapist she tried was the charm. Within a couple of months, she was pain free and had regained full range of motion. He was so good she added him to her healthcare team.

Now he is her personal trainer (with physical therapy on the rare instances when she needs it.) Today she is lifting heavy weights and doing shoulder presses and pullups.

The take home lesson is clear. Don’t let yourself be rushed into corticosteroid shots or surgery without trying physical therapy first. It’s worth the investment.

What Does This Study Mean For You?

Let me share a few quotations from the Discussion section of this study and interpret what they mean for you.

The Authors: “These findings have important implications for test interpretation in routine clinical care. In middle-aged and older adults, the extremely high probability of MRI-detected rotator cuff changes – approaching 100% in individuals over the age of 50 – means that the mere presence of an [MRI-detected] abnormality has limited diagnostic value.”

Your Take-Away: Don’t be stampeded into corticosteroid injections or shoulder surgery simply because MRI imaging of your shoulder detects tears or other abnormalities. Those changes could simply represent normal aging.

The Authors: “A positive MRI result does not confirm causality [meaning that abnormalities detected by MRI imaging are not necessarily responsible for the pain or loss of mobility you are experiencing] unless features such as a clear traumatic event [injury], acute strength loss, or persistent functional deficit increase the probability [of shoulder injury].”

Your Take-Away: If your shoulder pain is due to injury, you are experiencing severe loss of strength or range of motion, and these problems are persistent, you may wish to consult a shoulder specialist to determine your best course of action. In this case, MRI imaging does not play a diagnostic role, but it may help determine the best form of intervention.

However, corticosteroid therapy has significant side effects and shoulder surgery is not a minor surgical procedure. As my wife’s example shows, it is worth trying more natural approaches before taking the drug or surgical route. In my wife’s case, physical therapy, chiropractic care, and anti-inflammatory nutritional support help her avoid drugs and surgery.

The Authors: They closed by adding a very insightful comment about the way we should describe and think about MRI imaging.

“Reframing [MRI imaging] findings as normal age-related changes rather than disease may help guide more appropriate care and reduce unnecessary interventions…[This] may help avoid language that implicitly suggests that something is broken and requires fixing. Such terminology may reduce patient anxiety, discourage unnecessary surgical interventions, and help minimize overdiagnoses and overtreatment.”

Your Take-Away: It would be wonderful if every doctor reads this article, but most simply don’t have the time. So, when confronted with troubling MRI or X-ray results, you may want to ask a few questions like:

• “Are these results typical for someone my age?”

• “Is this something that should be watched or does it require immediate action?”

• “Are there any natural approaches or treatment options you recommend?”

That last question may require some discussions with your healthcare provider. I have my doctor well trained. She starts with, “There is a drug for that” and quickly switches to “But I know you aren’t interested in that. Here are some natural options to consider.

The Bottom Line

Most of us experience shoulder pain and loss of range of motion at one or more times in our lives. If the problem is persistent and we consult our physician, they often order MRI imaging as the first step to see whether medical treatment is necessary. But is that the best tool for diagnosing shoulder injuries?

A recent study looked at the value of MRI imaging of shoulders as a diagnostic tool for determining the need for drug therapy or surgery. The study found:

• MRI imaging detected rotator cuff abnormalities in 98.7% of the population over the age of 40.

• Rotator cuff abnormalities showed age-related progression, with milder findings in younger participants and more advanced structural damage in older participants.

• Rotator cuff abnormalities were identical in the symptomatic shoulder and the asymptomatic shoulder of individuals with shoulder pain or dysfunction.

The authors concluded, “In this population-based study, rotator-cuff abnormalities [detected by MRI imaging] were nearly universal after age 40 years and showed poor correlation with shoulder symptoms. These findings suggest that rotator cuff abnormalities represent normal age-related changes rather than disease and call into question the clinical value of routine imaging for shoulder pain.”

For more details about this study and what it means for you, read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

________________________________________________________________________________________________

My posts and “Health Tips From the Professor” articles carefully avoid claims about any brand of supplement or manufacturer of supplements. However, I am often asked by representatives of supplement companies if they can share them with their customers.

My answer is, “Yes, as long as you share only the article without any additions or alterations. In particular, you should avoid adding any mention of your company or your company’s products. If you were to do that, you could be making what the FTC and FDA consider a “misleading health claim” that could result in legal action against you and the company you represent.

For more detail about FTC regulations for health claims, see this link.

https://www.ftc.gov/business-guidance/resources/health-products-compliance-guidance

________________________________________________________________________________________

About The Author 

Dr. Chaney has a BS in Chemistry from Duke University and a PhD in Biochemistry from UCLA. He is Professor Emeritus from the University of North Carolina where he taught biochemistry and nutrition to medical and dental students for 40 years.  Dr. Chaney won numerous teaching awards at UNC, including the Academy of Educators “Excellence in Teaching Lifetime Achievement Award”.

Dr Chaney also ran an active cancer research program at UNC and published over 100 scientific articles and reviews in peer-reviewed scientific journals. In addition, he authored two chapters on nutrition in one of the leading biochemistry text books for medical students.

Since retiring from the University of North Carolina, he has been writing a weekly health blog called “Health Tips From the Professor”. He has also written two best-selling books, “Slaying the Food Myths” and “Slaying the Supplement Myths”. And most recently he has created an online lifestyle change course, “Create Your Personal Health Zone”. For more information visit https://chaneyhealth.com.

For the past 54 years Dr. Chaney and his wife Suzanne have been helping people improve their health holistically through a combination of good diet, exercise, weight control and appropriate supplementation.