Show Notes
The FIMAGE study scanned both shoulders of 602 adults from the general population using high-resolution 3-Tesla MRI. Only 7 had a structurally normal rotator cuff. In this episode, I walk through what the study found, why 78% of full-thickness tears were in people with no shoulder pain, and what happens to the diagnostic value of a scan when the finding it detects is near-universal. I challenge the assumption that prevalence equals normality, explore why the word "tear" imports a trauma narrative into what is usually a degenerative process, and make the case that imaging findings deserve a smaller seat at the clinical reasoning table than we've historically given them.
Key resources
Ibounig T et al. Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging. JAMA Intern Med. 2026 Apr 1;186(4):406-414. doi: 10.1001/jamainternmed.2025.7903. PMID: 41697693; PMCID: PMC12910452.
Englund M et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008 Sep 11;359(11):1108-15. doi: 10.1056/NEJMoa0800777. PMID: 18784100; PMCID: PMC2897006.
Jensen MC et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med. 1994 Jul 14;331(2):69-73. doi: 10.1056/NEJM199407143310201. PMID: 8208267.
Register for the complete shoulder online course
Register for my Brisbane workshop
Connect with Jared and guests:
Jared on Instagram: @shoulder_physio
Jared on X: @jaredpowell12
See our Disclaimer here: The Shoulder Physio - Disclaimer
More from The Shoulder Physio Podcast
Jared is joined by Professor Chad Cook who is one of the great researchers and academics in the field of physical therapy.
Jared is joined by Professor Jeremy Lewis who really needs no introduction but we will give him one just for fun.
The supraspinatus is one of the most misunderstood muscles in the human body. This episode aims to correct that.
A peanut isn't dangerous until it meets someone who can't tolerate it. Same with the upright row exercise. This episode scrutinises the "worst exercise for your shoulder" claim by tracing it back to a theory that's already dead, then shows what determines outcome: the person lifting. Shock. Horror.
Jared is joined by Tim Cook who is Senior Lecturer in Physiotherapy at the University of Chichester, Advanced Physiotherapy Practitioner in the NHS, and doctoral researcher to discuss their new paper with Prof. Jeremy Lewis in the Journal of Manual & Manipulative Therapy: "Rethinking strength testing in rotator cuff-related shoulder pain: a clinical tradition that lacks muscle."