February 23, 2026

@michaelokun

Rotator cuff abnormalities on MRI were present in 99% of adults aged 41 to 76. We need to avoid over-reaction to rotator cuff findings, especially in Parkinson’s and Alzheimer’s. MRI stands for magnetic resonance imaging and it uses powerful magnets to create detailed pictures of muscles, tendons and other tissues inside the body. Ibounig and colleagues describe in a new paper in JAMA Internal Medicine how rotator cuff abnormalities on MRI may be nearly universal after age 40 and frequently do not explain shoulder symptoms. My take: These findings should resonate deeply across neurology, especially for Parkinson’s and Alzheimer’s. We frequently obtain MRI scans for falls, pain, weakness or stiffness and discover structural abnormalities. However, structure does not always equal symptoms. Parkinson’s rigidity, bradykinesia and postural instability can all contribute to shoulder dysfunction independent of the MRI findings. Alzheimer’s disease adds another layer where communication challenges and altered pain perception complicate interpretation. Over-reacting to MRI findings can expose folks to unnecessary procedures, anxiety and harm. Imaging should support the clinical story, not replace it. Going a little slower and following folks over time with a collaborative approach between orthopedic docs and neurologists may help us sort out these cases. Here are 5 points that resonated w/ me: 1- Abnormal MRI findings are extremely common after age 40 and frequently reflect normal aging rather than disease. 2- A tear on MRI does not automatically explain pain, weakness or disability. 3- Clinical examination and the story matter more than imaging alone when deciding next steps. 4- Folks w/ Parkinson’s or Alzheimer’s may have shoulder symptoms driven by brain and movement changes rather than just tendon damage. This one is my extrapolation based on the data in the paper as this paper was not specifically about PD or AD. 5- Avoiding over-reaction to imaging can help prevent unnecessary procedures and focus care on improving real world function. https://cutt.ly/xtQ9LqQj #michaelokun #fixelinstitute