Rotator Cuff Imaging Abnormalities in Asymptomatic Shoulders: A Systematic Review.

OBJECTIVE

To estimate the prevalence of rotator cuff (RC) imaging abnormalities (tendinopathy, partial-thickness tear, full-thickness tear, or calcification) on radiograph, ultrasound, computed tomography, or magnetic resonance imaging (MRI) in asymptomatic adult shoulders. STUDY

DESIGN

Systematic review. LITERATURE SEARCH: Ovid MEDLINE, Embase, CINAHL, and Web of Science (searched September 1, 2024), with forward and backward citation searches. STUDY SELECTION CRITERIA: We included studies reporting the prevalence of RC abnormalities on imaging of asymptomatic shoulders. DATA SYNTHESIS: Due to heterogeneity, data were synthesized without meta-analysis. Risk of bias was assessed using a tool for prevalence studies. Certainty of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

After screening 3801 records and 188 studies in full text, we included 53 studies (29 ultrasound, 24 MRI) across population-based, miscellaneous, and athlete populations. The certainty of evidence was low to very low. For full-thickness tears, prevalence on ultrasound was 11% to 17% in 2 population-based samples (1631 shoulders), 0% to 35% across 14 studies of miscellaneous populations (3390 shoulders), and 0% to 22% across 4 studies of athlete populations (346 shoulders). On MRI, the prevalence was 20% in 1 population-based study (20 shoulders), 0% to 14% across 10 studies of miscellaneous populations (490 shoulders), and 0% to 11% across 12 studies of athlete populations (326 shoulders). For tendinopathy and/or partial-thickness tears, the prevalence on ultrasound was 34% in 1 population-based sample (539 shoulders), 0% to 47% across 11 studies of miscellaneous populations (1971 shoulders), and 7% to 70% across 4 studies of athlete populations (346 shoulders). On MRI, the prevalence was 65% in 1 population-based sample (20 shoulders), 0% to 100% across 10 studies of miscellaneous populations (490 shoulders), and 6% to 96% across 13 studies of athlete populations (426 shoulders).

CONCLUSION

Across studies with low- to very low-certainty of evidence, the prevalence of RC imaging abnormalities in asymptomatic shoulders ranged from 0% to 100%. J Orthop Sports Phys Ther 2025;55(12):1-16. Epub 5 November 2025. doi:10.2519/jospt.2025.13611.