MRI testing of the shoulder is no different than testing in other body regions. Pathologies such as bursa changes, tendinopathies, labral and rotator cuff tears are very common in asymptomatic populations and tend to increase with an individual's age. Many of these MRI findings do not contribute to a patient's current symptoms and may be reflective instead of the natural aging process in the shoulder. Conversely, some pathologies such as rotator cuff tears may explain a patient's symptoms especially when these findings match the patient's subjective history or clinical examination.
Tran and colleagues sought to answer this question by reviewing the available evidence on shoulder MRI findings and a patient's symptoms and prognosis (Arthritis Care Res. 2018). Authors reviewed 56 papers and found no significant association between most imaging findings and current symptoms. One exception was enlarging rotator cuff tears which were shown to be associated with an increased incidence of symptoms. In general, the majority of these studies were low in quality and authors called for high quality studies on this topic.