{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T06:43:37Z","timestamp":1793515417533,"version":"4.5.0"},"reference-count":38,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec id=\"ab-ioi250098-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Shoulder pain is a common musculoskeletal complaint often attributed to rotator cuff (RC) abnormalities. Diagnostic imaging is frequently used, but the association between RC abnormalities and shoulder symptoms remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250098-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the prevalence of RC abnormalities in a general population sample and their association with shoulder symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250098-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>Population-based cross-sectional study in a nationally representative random sample of adults aged 41 to 76 years who underwent standardized clinical assessment and bilateral 3-Tesla magnetic resonance imaging (MRI) of the shoulders conducted from February 2023 to April 2024 in Finland. Eligibility criteria included ability to undergo MRI and absence of previous shoulder replacement surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250098-7\">\n                    <jats:title>Exposures<\/jats:title>\n                    <jats:p>Structured interviews, standardized questionnaires, clinical shoulder tests, and shoulder MRI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250098-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>RC tendon status was classified on MRI as normal, tendinopathic, partial-thickness tear (PTT), or full-thickness tear (FTT). Shoulder symptoms were defined as pain or dysfunction in the preceding week. The prevalence of RC abnormalities was compared across age groups and between symptomatic and asymptomatic shoulders, adjusting for demographic factors, concurrent MRI findings, and clinical examination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250098-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 602 participants (median age, 58 [range, 41-76] years; 52% female), RC abnormalities on MRI were found in 595 (98.7%; 95% CI, 97.5%-99.5%): 25% tendinopathy, 62% PTT, and 11% FTT. The prevalence and severity of abnormalities increased with age but did not differ between sexes. RC abnormalities were present in 96% of asymptomatic shoulders (1039 of 1076) and 98% of symptomatic shoulders (126 of 128). Only FTTs were more prevalent in symptomatic shoulders (14.6%) than in asymptomatic shoulders (6.5%), but this difference diminished after adjustment (absolute difference, 0.8%; 95% CI, \u22123.4% to 6.0%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-ioi250098-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this population-based study, RC abnormalities were nearly universal after age 40 years and showed poor concordance with shoulder symptoms. These findings suggest that RC abnormalities often represent normal age-related changes rather than disease and call into question the clinical value of routine imaging for atraumatic shoulder pain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamainternmed.2025.7903","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T16:30:35Z","timestamp":1771259435000},"page":"406","source":"Crossref","is-referenced-by-count":23,"title":["Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging"],"prefix":"10.1001","volume":"186","author":[{"given":"Thomas","family":"Ibounig","sequence":"first","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland"},{"name":"Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teppo L. N.","family":"J\u00e4rvinen","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland"},{"name":"Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saara","family":"Raatikainen","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland"},{"name":"Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommi","family":"H\u00e4rk\u00e4nen","sequence":"additional","affiliation":[{"name":"Department of Public Health, Finnish Institute for Health and Welfare (THL), Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niko","family":"Sillanp\u00e4\u00e4","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland"},{"name":"Department of Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Bensch","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland"},{"name":"Department of Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ville","family":"Haapam\u00e4ki","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland"},{"name":"Department of Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pirjo","family":"Toivonen","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland"},{"name":"Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Bj\u00f6rkenheim","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland"},{"name":"Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anssi","family":"Ry\u00f6s\u00e4","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland"},{"name":"Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kari","family":"Kanto","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland"},{"name":"Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vesa","family":"Lepola","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antti","family":"Joukainen","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Paavola","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seppo","family":"Koskinen","sequence":"additional","affiliation":[{"name":"Department of Public Health, Finnish Institute for Health and Welfare (THL), Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lasse","family":"R\u00e4m\u00f6","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland"},{"name":"Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachelle","family":"Buchbinder","sequence":"additional","affiliation":[{"name":"Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simo","family":"Taimela","sequence":"additional","affiliation":[{"name":"Finnish Centre for Evidence-Based Orthopaedics, University of Helsinki, Helsinki, Finland"},{"name":"Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"2","key":"ioi250098r1","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1080\/03009740310004667","article-title":"Prevalence and incidence of shoulder pain in the general population; a systematic review.","volume":"33","author":"Luime","year":"2004","journal-title":"Scand J Rheumatol"},{"issue":"11","key":"ioi250098r4","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1136\/ard.57.11.649","article-title":"Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation.","volume":"57","author":"Urwin","year":"1998","journal-title":"Ann Rheum Dis"},{"issue":"4","key":"ioi250098r5","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1136\/ard.2005.037317","article-title":"Prevalence and risk factors for joint pain among men and women in the West of Scotland Twenty-07 study.","volume":"65","author":"Adamson","year":"2006","journal-title":"Ann Rheum Dis"},{"issue":"6","key":"ioi250098r6","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1093\/rheumatology\/keh598","article-title":"Diagnosis and relation to general health of shoulder disorders presenting to primary care.","volume":"44","author":"Ost\u00f6r","year":"2005","journal-title":"Rheumatology (Oxford)"},{"issue":"12","key":"ioi250098r7","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1136\/ard.54.12.959","article-title":"Shoulder disorders in general practice: incidence, patient characteristics, and management.","volume":"54","author":"van der Windt","year":"1995","journal-title":"Ann Rheum Dis"},{"issue":"3","key":"ioi250098r8","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1002\/acr.25189","article-title":"Patterns of imaging requests by general practitioners for people with musculoskeletal complaints: an analysis from a primary care database.","volume":"77","author":"Haas","year":"2025","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"4","key":"ioi250098r9","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1002\/msc.1497","article-title":"Guidelines for the use of diagnostic imaging in musculoskeletal pain conditions affecting the lower back, knee and shoulder: a scoping review.","volume":"18","author":"Cuff","year":"2020","journal-title":"Musculoskeletal Care"},{"issue":"11","key":"ioi250098r10","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011048","article-title":"Ultrasound imaging to tailor the treatment of acute shoulder pain: a randomised controlled trial in general practice.","volume":"6","author":"Ottenheijm","year":"2016","journal-title":"BMJ Open"},{"issue":"4","key":"ioi250098r11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0061243","article-title":"General practitioner management of shoulder pain in comparison with rheumatologist expectation of care and best evidence: an Australian national survey.","volume":"8","author":"Buchbinder","year":"2013","journal-title":"PLoS One"},{"issue":"1","key":"ioi250098r12","doi-asserted-by":"publisher","first-page":"50","DOI":"10.5694\/j.1326-5377.2008.tb01507.x","article-title":"The clinical utility of ultrasonography for rotator cuff disease, shoulder impingement syndrome and subacromial bursitis.","volume":"188","author":"Awerbuch","year":"2008","journal-title":"Med J Aust"},{"issue":"3","key":"ioi250098r14","doi-asserted-by":"publisher","first-page":"227","DOI":"10.2106\/JBJS.J.00739","article-title":"National trends in rotator cuff repair.","volume":"94","author":"Colvin","year":"2012","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"ioi250098r15","doi-asserted-by":"publisher","first-page":"1052","DOI":"10.1186\/s12891-021-04938-7","article-title":"Increasing incidence of rotator cuff surgery: A nationwide registry study in Chile.","volume":"22","author":"Vidal","year":"2021","journal-title":"BMC Musculoskelet Disord"},{"issue":"1","key":"ioi250098r16","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1302\/0301-620X.96B1.32556","article-title":"Temporal trends and geographical variation in the use of subacromial decompression and rotator cuff repair of the shoulder in England.","volume":"96-B","author":"Judge","year":"2014","journal-title":"Bone Joint J"},{"issue":"11","key":"ioi250098r17","doi-asserted-by":"publisher","first-page":"1108","DOI":"10.1056\/NEJMoa0800777","article-title":"Incidental meniscal findings on knee MRI in middle-aged and elderly persons.","volume":"359","author":"Englund","year":"2008","journal-title":"N Engl J Med"},{"issue":"2","key":"ioi250098r18","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1056\/NEJM199407143310201","article-title":"Magnetic resonance imaging of the lumbar spine in people without back pain.","volume":"331","author":"Jensen","year":"1994","journal-title":"N Engl J Med"},{"issue":"9","key":"ioi250098r19","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1001\/jama.1994.03510330081039","article-title":"Users\u2019 guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The Evidence-Based Medicine Working Group.","volume":"271","author":"Jaeschke","year":"1994","journal-title":"JAMA"},{"issue":"1","key":"ioi250098r20","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s13018-024-05378-4","article-title":"Imaging abnormalities of the acromioclavicular joint and subacromial space are common in asymptomatic shoulders: a systematic review.","volume":"20","author":"Ibounig","year":"2025","journal-title":"J Orthop Surg Res"},{"issue":"10","key":"ioi250098r21","doi-asserted-by":"publisher","first-page":"1184","DOI":"10.1016\/j.joca.2024.06.001","article-title":"Systematic Review of Shoulder Imaging Abnormalities in Asymptomatic Adult Shoulders (SCRUTINY): abnormalities of the glenohumeral joint.","volume":"32","author":"Ibounig","year":"2024","journal-title":"Osteoarthritis Cartilage"},{"issue":"8","key":"ioi250098r22","doi-asserted-by":"publisher","first-page":"1169","DOI":"10.1002\/acr.23554","article-title":"What imaging-detected pathologies are associated with shoulder symptoms and their persistence? A systematic literature review.","volume":"70","author":"Tran","year":"2018","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"12","key":"ioi250098r23","doi-asserted-by":"publisher","first-page":"1913","DOI":"10.1016\/j.jse.2014.08.001","article-title":"A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age.","volume":"23","author":"Teunis","year":"2014","journal-title":"J Shoulder Elbow Surg"},{"issue":"12","key":"ioi250098r24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2519\/jospt.2025.13611","article-title":"Rotator cuff imaging abnormalities in asymptomatic shoulders: a systematic review.","volume":"55","author":"Sanders","year":"2025","journal-title":"J Orthop Sports Phys Ther"},{"issue":"12","key":"ioi250098r25","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-074457","article-title":"Concordance of shoulder symptoms and imaging findings: a protocol for the Finnish Imaging of Shoulder (FIMAGE) study.","volume":"13","author":"Ibounig","year":"2023","journal-title":"BMJ Open"},{"issue":"4","key":"ioi250098r28","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1002\/art.1790040403","article-title":"Development of a shoulder pain and disability index.","volume":"4","author":"Roach","year":"1991","journal-title":"Arthritis Care Res"},{"issue":"214","key":"ioi250098r29","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1097\/00003086-198701000-00023","article-title":"A clinical method of functional assessment of the shoulder.","author":"Constant","year":"1987","journal-title":"Clin Orthop Relat Res"},{"issue":"6","key":"ioi250098r30","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1016\/j.jse.2007.02.123","article-title":"Comparison of the subjective shoulder value and the Constant score.","volume":"16","author":"Gilbart","year":"2007","journal-title":"J Shoulder Elbow Surg"},{"issue":"1","key":"ioi250098r31","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1148\/radiology.172.1.2740508","article-title":"Rotator cuff tears: diagnostic performance of MR imaging.","volume":"172","author":"Zlatkin","year":"1989","journal-title":"Radiology"},{"issue":"Pt 1","key":"ioi250098r32","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1348\/000711006X126600","article-title":"Computing inter-rater reliability and its variance in the presence of high agreement.","volume":"61","author":"Gwet","year":"2008","journal-title":"Br J Math Stat Psychol"},{"issue":"8","key":"ioi250098r34","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1111\/1756-185X.12476","article-title":"Prevalence of abnormalities on shoulder MRI in symptomatic and asymptomatic older adults.","volume":"17","author":"Gill","year":"2014","journal-title":"Int J Rheum Dis"},{"issue":"9","key":"ioi250098r35","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-059175","article-title":"Prevalence of rotator cuff tendon tears and symptoms in a Chingford general population cohort, and the resultant impact on UK health services: a cross-sectional observational study.","volume":"12","author":"Hinsley","year":"2022","journal-title":"BMJ Open"},{"issue":"1","key":"ioi250098r36","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/j.jse.2009.04.006","article-title":"Prevalence and risk factors of a rotator cuff tear in the general population.","volume":"19","author":"Yamamoto","year":"2010","journal-title":"J Shoulder Elbow Surg"},{"issue":"12","key":"ioi250098r37","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000019579","article-title":"Comparison of MRI and MRA for the diagnosis of rotator cuff tears: a meta-analysis.","volume":"99","author":"Liu","year":"2020","journal-title":"Medicine (Baltimore)"},{"issue":"9","key":"ioi250098r38","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009020.pub2","article-title":"Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered.","volume":"2013","author":"Lenza","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"ioi250098r3","volume-title":"Health, Functional Capacity and Welfare in Finland in 2011","author":"Koskinen","year":"2012"},{"key":"ioi250098r2","unstructured":"Kaila-Kangas? L, ed. Musculoskeletal disorders and diseases in Finland: results of the Health 2000 survey. The National Public Health Institute; 2007. Accessed December 19, 2025. https:\/\/www.julkari.fi\/server\/api\/core\/bitstreams\/969b2990-3936-41b1-a469-062e573f4d56\/content"},{"key":"ioi250098r13","unstructured":"Australian Government Services Australia. Medicare Item Reports. 2025. Accessed May 15, 2025. https:\/\/medicarestatistics.humanservices.gov.au\/statistics\/mbs_item.html"},{"key":"ioi250098r26","unstructured":"Heistaro? S. Methodology report: Health 2000 survey. National Public Health Institute; 2008. Accessed December 19, 2025. https:\/\/www.julkari.fi\/server\/api\/core\/bitstreams\/eff82691-7cc7-4836-aa0a-0ee9dbed3d52\/content"},{"key":"ioi250098r27","unstructured":"Aromaa? A, Koskinen? S. Health and functional capacity in Finland: baseline results of the Health 2000 health examination survey. 2004. Accessed December 19, 2025. https:\/\/www.julkari.fi\/server\/api\/core\/bitstreams\/a2d594ee-4c2a-4861-bd4b-df3776fd7542\/content"},{"key":"ioi250098r33","unstructured":"Lundqvist? A, M\u00e4ki-Opas? T. Health 2011 survey\u2014methods. The National Institute for Health and Welfare; 2016. Accessed December 19, 2025. https:\/\/www.julkari.fi\/server\/api\/core\/bitstreams\/e9dd181a-e46b-4fdf-9812-6311d2eb5d4f\/content"}],"container-title":["JAMA Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/articlepdf\/2844659\/jamainternal_ibounig_2026_oi_250098_1774053161.92442.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T15:00:34Z","timestamp":1775487634000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2844659"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":38,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamainternmed.2025.7903","relation":{},"ISSN":["2168-6106"],"issn-type":[{"value":"2168-6106","type":"print"}],"subject":[],"published":{"date-parts":[[2026,4,1]]}}}