X-rays and MRI’s on the shoulder: the truth about shoulder pain

If you have shoulder pain, you may have been told that you have an issue that's caused by something you can see in an X-ray or MRI. Maybe it's a labral tear. Or a rotator cuff tear. Maybe someone says your acromion process or your clavicle is too long. You may have been told surgery is the best answer to correct the problem with your bones, labrum, muscle, etc.

Do X-rays and MRIs give you the whole story on shoulder pain?

It's a common belief that X-rays and MRIs can help you pinpoint the cause of your shoulder pain. The reality is that X-rays and MRIs only provide a picture, and those pictures are interpreted to mean far more than they actually tell us.

This is a familiar pattern in the realm of knee meniscus surgeries as well with spinal surgeries. At one point, doctors generally believed the "pathologies" they saw in X-rays and MRIs were the actual causes of problems. Over time, the X-rays and MRIs turned out to be not all that useful.

The same pattern appears to be happening with shoulder pain issues. To get perspective on this, studies have been conducted to determine just how useful X-rays and MRIs are for finding the source of pain.

There are a number of common pathologies that show up in X-ray and MRI that get blamed for shoulder pain. If these pathologies are, in fact, the causes of shoulder pain, we should expect to see a very strong correlation between the presence of pathology and a person having pain. Put another away, if you have a problem in the X-ray or MRI, you also have pain and movement dysfunction. This should be a very consistently observed relationship.

Studies do not demonstrate this relationship in any consistent manner. Whether it's rotator cuff tears, labral tears, poor bone shapes, etc. the relationships just aren't there! When you do X-rays and MRIs on people with NO symptoms of pain or range of motion issues, you STILL find pathologies! This means the pathologies that show up in X-rays and MRIs are highly unlikely to be the cause of shoulder pain, and they should not be the thing you focus on.

Here are a few studies that may interest you:

Worland, R. L., Lee, D., Orozco, C. G., SozaRex, F., & Keenan, J. (2003). Correlation of age, acromial morphology, and rotator cuff tear pathology diagnosed by ultrasound in asymptomatic patients. JOURNAL-SOUTHERN ORTHOPAEDIC ASSOCIATION, 12(1), 23-26.

Reilly, P., Macleod, I., Macfarlane, R., Windley, J., & Emery, R. J. H. (2006). Dead men and radiologists don't lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence. The Annals of The Royal College of Surgeons of England, 88(2), 116-121.

Gill, T. K., Shanahan, E. M., Allison, D., Alcorn, D., & Hill, C. L. (2014). Prevalence of abnormalities on shoulder MRI in symptomatic and asymptomatic older adults. International journal of rheumatic diseases, 17(8), 863-871.

Schwartzberg, R., Reuss, B. L., Burkhart, B. G., Butterfield, M., Wu, J. Y., & McLean, K. W. (2016). High prevalence of superior labral tears diagnosed by MRI in middle-aged patients with asymptomatic shoulders. Orthopaedic journal of sports medicine,4(1), 2325967115623212.


So what can you do if you have shoulder pain?

If the shoulder "pathologies" that show up in X-ray and MRI are not the cause of your shoulder pain, it makes sense to wonder - WHAT IS? We would suggest looking at the muscles that control the shoulder joint. Muscles directly and obviously affect the quality of motion at your shoulder, and they can be retrained to improve your range of motion and comfort levels. 

Retraining shoulder function is NOT a quick fix solution. If it works, it usually will take at least a few weeks to a few months...even to a few years! It's a process of learning and discovering things that will require your attention and dedication. But it's also the cheapest way to fix your shoulder and the one that gives you most power to continue to enjoy your life and the sports and activities you love! 

Want shoulders that feel good and move well?


About the Author

Matt Hsu is a trainer and orthopedic massage therapist. He fought a long battle with chronic pain all over his body and won. He blends the principles he learned in his journey, empirical observations with clients, and relevant research to help others get their lives back.