Shoulder MRI Findings in People with NO Shoulder Pain: Are Some Tears “Normal”

Your shoulder hurts and you see your doctor.  You expect an MRI to be performed, and many doctors will oblige you and order that MRI.  But .. what if I told you that almost no one has a “normal” shoulder MRI?  What if I told you that before your injury, or before your pain started your MRI might have shown tears simply because we age and wear out? Shoulder MRIs performed too soon often lead to unnecessary surgery.   Many of the changes we see on a shoulder MRI are simply a consequence of activity and aging.

We have a huge problem in the United States where you as a patient are being over-diagnosed and over-treated.  This has been an emerging trend for a while.  We have a high-tech low-touch approach to treating patients.  Many physicians will look at an MRI reading and tell you what’s wrong and that you need surgery to fix it.  We deserve far better than that.

Do I really need that MRI?

Many patients who hear the word “tear”, think (understandably) that must mean that it is abnormal and often choose to have the tear fixed when their physician recommends it.  It sounds logical.. no?  Unfortunately, many of your parts in your body wear out.  They fray, they tear and those findings frequently mean nothing.   Most of you with labral tears in your shoulder, especially superior labral tears or SLAP lesions have had them for years before your shoulder was MRI performed.  Yes.. the tear was pre-existing … and therefore may NOT be the source of your pain and thus does NOT require surgery.

A recent scientific paper reported the results of a shoulder MRI performed in 50 patients between 40 and 60 years of age.

The authors concluded:

To avoid overtreatment, physicians should realize that superior labral tears diagnosed by MRI in individuals between the ages of 45 and 60 years may be normal age-related findings.

The authors found that upwards of 70% of shoulders had a superior labral tear- or a SLAP lesion.  Again, that means that 70% of people between 40 and 60 years of age have these “tears” and do not know it.  Yes, many were overhead athletes, and many were very active.

Shoulder MRI will almost always find something wrong

There is no doubt that labral tears and SLAP lesions are being over-diagnosed and therefore over-treated.  That translates to many people having unnecessary surgery on the shoulder.  What we know about SLAP lesion surgery is that:

• It is a surgery with a high incidence of post surgical stiffness as a complication.
• A surgery with a very high failure rate.
• A surgery that most of you do not need performed.
• A surgery with a long convalescence– often times meaning months out of work.

Shoulder MRI findings do not often require treatment

Bottom Line:

An MRI performed on patients with no shoulder pain can reveal a very high rate of labral tears, specifically superior labral tears or SLAP lesions.  Obtaining a routine MRI because you have had shoulder pain for a week from working out hard, or you were working in your garden for a few hours is not a wise decision on the part of your doctor. Time, rest, and PT tend to work very well at restoring your function and alleviating your pain– for most of you.   If your Orthopedist will not see you unless you already had an MRI — well, you need a new Orthopedist.  We should endeavor to treat patients, not MRI findings — and all the recent scientific literature shows that this approach is the proper one.

In addition, without a detailed history — your story, and physical exam it is impossible to determine if the findings on the MRI are potentially the source of your pain.

Before you consider going for that MRI because you’ve had a week or two of shoulder pain you need to keep in mind that there is a strong chance that the MRI will reveal something.