“What Should I Do If My Shoulder MRI Shows a Tear?”

Question: Doctor, my shoulder was hurting, so I had an MRI. The report says I have a "rotator cuff tear." Is this something very serious?

First of all, don't panic. A large Finnish study published in JAMA Internal Medicine in 2026 showed that 99% of individuals between the ages of 41 and 76 had some form of rotator cuff abnormality on MRI. Even more importantly, 96% of these findings were in shoulders with no pain at all. In other words, an MRI "tear" is often a natural age-related change that develops in almost everyone's shoulder — much like gray hair.

Question: Then why do I have pain?

The source of pain does not always match the structural finding seen on MRI. Pain may arise from inflammation within the tendon, muscle imbalance, or other surrounding structures of the shoulder. That's why treatment decisions should be based not on the MRI alone, but on your symptoms and physical examination findings.

Question: What exactly is the rotator cuff?

The tendons of four muscles surrounding the shoulder join together to form a sleeve-like structure called the "rotator cuff." This structure allows you to lift your arm, rotate it, and move it behind your back. Rotator cuff disorders are responsible for more than half of all shoulder complaints.

Question: If I exercise, won't the tear get bigger?

I hear this question very often. Exercises performed according to proper loading principles strengthen the tendon rather than enlarging the tear. In fact, avoiding movement may accelerate muscle wasting and worsen the condition. The type and intensity of exercise should be individualized, but avoiding exercise is not the solution.

Question: Does non-surgical treatment really work?

In most cases, yes. An international guideline published in 2025 recommends physical therapy and exercise as the first-line treatment for the majority of rotator cuff tears. In small- to medium-sized tears, non-surgical treatment often provides results comparable to surgery. When necessary, corticosteroid or PRP injections may also support the recovery process.

Question: So when is surgery necessary?

There are several situations in which surgery may become the preferred option: large tears that occur after sudden trauma such as a fall or impact, persistent pain and weakness despite 3–6 months of appropriate conservative treatment, or advanced muscle atrophy associated with a large tear on MRI. However, this decision must always be individualized; not every large tear requires surgery.

Question: So let's go back to the beginning. Does every patient with shoulder pain need an MRI?

No. In fact, unnecessary MRI scans can sometimes create even more anxiety — because almost everyone will have some type of "finding." We mainly use MRI after traumatic acute weakness, when conservative treatment fails, or during surgical planning. The first step should always be a thorough clinical examination.

You can schedule an appointment so we can evaluate your shoulder pain together.

References:

Ibounig T et al., JAMA Internal Medicine, 2026

Desmeules F et al., Journal of Orthopaedic & Sports Physical Therapy, 2025

Medicina 2026;62(2):272