Sher et al. prospectively imaged the dominant shoulder of 96 rigorously screened asymptomatic volunteers across three age groups. The study determined the true prevalence of rotator cuff tears on MRI in people with no shoulder pain, no functional limitation, and a normal physical exam. All subjects were excluded if they had any prior shoulder symptoms, surgery, or abnormal findings on musculoskeletal examination.
A 65-year-old with mild shoulder discomfort gets an MRI showing a full-thickness supraspinatus tear. The reflex is to offer surgery. This paper is why that reflex is wrong without a careful clinical exam.
When imaging findings precede or outpace symptoms, treat the patient — not the scan. A tear in someone over 60 has roughly even odds of being incidental. The decision to operate requires corroborating clinical evidence: pain that limits function, failed conservative care, and a physical exam consistent with the imaged pathology.
Age-adjust your MRI interpretation. A full-thickness tear in a 35-year-old is alarming. The same finding in a 70-year-old with modest symptoms may represent normal aging. The strong association between full-thickness tears and AC osteoarthrosis plus subacromial spurs reinforced the degenerative impingement model. The mechanistic foundation for acromioplasty as an adjunct to cuff repair.
Sher et al. prospectively imaged the dominant shoulder of 96 rigorously screened asymptomatic volunteers across three age groups. The study determined the true prevalence of rotator cuff tears on MRI in people with no shoulder pain, no functional limitation, and a normal physical exam. All subjects were excluded if they had any prior shoulder symptoms, surgery, or abnormal findings on musculoskeletal examination.
A 65-year-old with mild shoulder discomfort gets an MRI showing a full-thickness supraspinatus tear. The reflex is to offer surgery. This paper is why that reflex is wrong without a careful clinical exam.
When imaging findings precede or outpace symptoms, treat the patient — not the scan. A tear in someone over 60 has roughly even odds of being incidental. The decision to operate requires corroborating clinical evidence: pain that limits function, failed conservative care, and a physical exam consistent with the imaged pathology.
Age-adjust your MRI interpretation. A full-thickness tear in a 35-year-old is alarming. The same finding in a 70-year-old with modest symptoms may represent normal aging. The strong association between full-thickness tears and AC osteoarthrosis plus subacromial spurs reinforced the degenerative impingement model. The mechanistic foundation for acromioplasty as an adjunct to cuff repair.