Finnish researchers looked at shoulder MRIs of more than 600 adults over the age of 40. Here’s a quote from their 2026 article published in JAMA’s Internal Medicine:

The findings of this study suggest that rotator cuff abnormalities are nearly universal after age 40 years and that routine imaging should not guide diagnosis or treatment of atraumatic shoulder pain.

We use the same three words — “rotator cuff tear” — to talk about two entirely different things.

One type of rotator cuff tear occurs from an injury in a young person in their teens or twenties. In this population, there may not be significant pre-existing degeneration of the rotator cuff or other shoulder structures; instead, the tear has resulted from a sudden injury. They might benefit from a specific injury-healing treatment or, if the tear is extensive enough, surgery to repair it.

A second type of “rotator cuff tear” shows up on the MRI of a person over 40. In people over 40, as the Finnish study shows, MRI abnormalities of the rotator cuff are almost universal whether the person has shoulder pain or not. The MRI appearance is almost useless in determining the optimal treatment approach.

In my practice, I typically assess the functionality, not the anatomical integrity, of the shoulder joint and rotator cuff muscles. Often the foundational issues for those with pain in the shoulder region are

• the alignment of the spine and shoulder blade,
• the balanced use of the muscles that operate the shoulder joint, and
• the pattern of activation of the muscles that keep the arm bone centered in the socket.

Here’s a video I made to help you get started on your shoulder rehab program.

PS – MRIs aren’t very useful in diagnosing low back problems either.

Dr. Lavine has been an innovator in the use of movement and touch to promote health since 1981. He practices in New York City and Princeton, NJ.