“Almost as Common as Grey Hair”: New FICEBO study finds that after midlife, rotator cuff changes on MRI are almost as expected as grey hair

Rotator cuff “tears” on MRI are so common after age 40 that they are almost a normal part of ageing rather than a clear sign of disease, according to a large Finnish study (FIMAGE) that challenges how doctors diagnose and discuss shoulder problems. The study was published in JAMA Internal Medicine on February 16, 2026

Researchers at FICEBO, the Finnish Centre for Evidence-Based Orthopaedics, scanned the shoulders of 602 adults from the general population and found that 99% had at least one rotator cuff abnormality, whether or not they had any shoulder pain.

“Put simply: if you’re over 40 and we give your shoulder an MRI, we are almost guaranteed to find something ‘wrong’ with your rotator cuff,” said lead author Dr. Thomas Ibounig, an orthopaedic researcher at FICEBO. “But our data show those findings usually don’t explain pain.”

Participants, aged 41 to 76, underwent detailed clinical shoulder exams and bilateral high-resolution MRI between February 2023 andApril 2024.

Overall, 25% of shoulders showed tendinopathy, 62% had partial-thickness tears, and 11% had full-thickness tears. Abnormalities became more frequent and more severe with age, but were equally common in men and women. Crucially, the same kinds of findings appeared in people with no shoulder symptoms at all.

Perhaps most surprising of all is that rotator cuff abnormalities were present in 96% of asymptomatic shoulders (1039/1076) and  in 98% of symptomatic shoulders (126/128)

“This is a near-universal phenomenon,” Dr. Ibounig said.“After midlife, rotator cuff changes on MRI are almost as expected as grey hair. They’re there in people who feel fine and in people who have pain.”

The study’s central question was whether what shows up on MRI actually matches who has pain or dysfunction. The short answer: not really.

Only full-thickness tears were somewhat more common in painful shoulders at first glance: 14.6% in symptomatic vs 6.5% in asymptomatic shoulders. But when the team adjusted for age, other MRI findings, and clinical exam results, even that difference nearly disappeared (absolute difference0.8%).

“In real-world terms, that means most of the so-called ‘tears’ we find on scans are not good explanations for why a particular shoulder hurts,” Ibounig said. “The correlation between imaging and symptoms is surprisingly weak.”

Because rotator cuff changes are so widespread in people without pain, the authors say routine MRI for atraumatic shoulder pain – that is, pain not caused by a clear injury – often adds little diagnostic value. The concern is that once a scan is done, the language of the report can drive care– and anxiety.

“If your MRI report says ‘partial-thickness tear’ or ‘degeneration,’ most people understandably assume that’s the cause of their pain and that it’s serious damage,” he said. “But our data suggest that in many cases, these are just age-related changes that happen whether you hurt or not.”

The authors argue that how clinicians and radiologists describe rotator cuff findings may be as important as whether they are present.

“When you all a common, age-related change a ‘tear’ it sounds dramatic and pathological,” Ibounig said. “It risks promoting fear, overdiagnosis, and overtreatment, including surgeries that may not help.”

He suggests more neutral, descriptive language that reflects the study’s findings:

“If we treat every MRI abnormality as a problem to be fixed, we will endlessly chase shadows,” Ibounig said. “We need to align our language, and our care, with the evidence.”

Rethinking the role of imaging

The study does not argue that MRI is never useful. In cases of significant trauma, red flag symptoms, or suspected large full-thickness tears with major functional loss, imaging can still play an important role.

But for the typical middle-aged person with gradual-onset shoulder pain, the authors say restraint is warranted.

“The default should not be: pain equals MRI equals surgery,”Ibounig said. “It should be: pain equals careful clinical assessment, education, and conservative management – and only then, imaging when it meaningfully changes decisions.”

For patients, the takeaway may be reassuring.

“If you’re over 40 and your shoulder MRI shows a ‘tear,’ it usually doesn’t mean your shoulder is falling apart,” Ibounig said. “It probably means you’re human, you’re ageing, and your rotator cuff looks a lot like everyone else’s.”