Understanding Your Shoulder Ultrasound Bursitis and Rotator Cuff Changes
Many patients are concerned when their shoulder ultrasound shows bursitis or a rotator cuff tear. These words can sound serious, but research shows that these findings are often part of normal aging and may not be the main cause of your pain. Understanding what these changes really mean can help you manage your shoulder effectively.
What is Bursitis?
The shoulder contains small fluid-filled sacs called bursae, which help reduce friction between tendons, muscles, and bones.
Bursitis occurs when a bursa becomes inflamed, sometimes appearing thicker or filled with fluid on an ultrasound.
Key points from research:
Many people without any shoulder pain have bursitis visible on imaging.
Mild bursitis is often part of normal wear-and-tear and does not always need treatment.
Why it matters: Your bursa may appear inflamed, but this doesn’t automatically mean it’s causing your pain. Other factors, like muscle weakness, posture, or
movement patterns, may play a bigger role.
Rotator Cuff Tears: Common With Age
The rotator cuff is a group of tendons that stabilizes and moves the shoulder.
Ultrasounds can reveal partial tears, thinning, or degenerative changes.
Age-related prevalence:
People in their 50s: up to 50% may have small tears without pain
People in their 60s–70s: many may have tears but normal function
Professional athletes example:
Studies of Major League Baseball pitchers show that many have rotator cuff
tears on imaging but remain completely asymptomatic and continue to
perform at an elite level.
Important points:
A tear on imaging does not always match your symptoms
Pain may be due to muscle weakness, stiffness, or nervous system sensitivity, not just the tear
Surgery is only required for severe tears causing significant weakness or functional loss
Why Imaging Can Be Misleading
Structural changes on scans often do not correlate with pain.
Common findings (bursitis, partial rotator cuff tears, tendon thickening) can occur in pain-free individuals.
Focusing solely on imaging can sometimes increase fear and anxiety, which may worsen pain or reduce movement.
How Physiotherapy Can Help
Even with age-related changes, physiotherapy can make a big difference:
1. Targeted Strengthening
Rotator cuff and scapular stabilizer exercises improve function and reduce strain.
2. Movement Retraining
Correcting movement patterns reduces irritation to tissues and helps prevent flare-ups.
3. Education
Explaining that age-related changes are normal and often harmless helps reduce fear.
4. Hands-on Techniques
Massage, joint mobilization, and stretching can relieve stiffness and improve range of motion.
5. Functional Guidance
Teaching safe ways to lift, reach, or perform daily activities reduces stress on the shoulder.
With this approach, many people experience reduced pain, improved shoulder function, and better quality of life, even if the scan shows structural changes.
Take-Home Message
Ultrasound findings such as bursitis or rotator cuff tears are very common and often age-appropriate.
Imaging is just one piece of the puzzle—how your shoulder moves, how strong it is, and how you use it matters more.
Even elite athletes can have tears and no pain—your shoulder can get stronger, move better, and be pain-free with the right physiotherapy approach.
Why Athletes (Like Baseball Pitchers) Can Have Rotator Cuff Tears — but No Pain
What the Research Shows
Imaging studies of asymptomatic professional pitchers have found surprisingly high rates of rotator cuff pathology. In one MRI study of 21 Major League Baseball pitchers, 11 (52%) had rotator cuff tears (mostly articularsurface) and labral tears, despite having no symptoms. (Ovid)
More recently, a study of 38 asymptomatic MLB pitchers showed that some MRI findings — like partial-thickness rotator cuff tears — were common, but these did not reliably predict whether a pitcher would go on to need major-league-levelinjury designation (“IL”). (PubMed)
In youth athletes, the phenomenon begins early: a study of Little League baseball players (ages ~10–12) found 52% had at least one abnormal MRI in their throwing shoulder (labral changes, partialthickness rotator cuff tears, bursitis), but none were clinically diagnosed or treated for significant shoulder injuries. (PMC)
From a sports medicine review: even though rotator cuff “tendon pathology” (like tendinosis or partial tears) is common on scans, many overhead athletes never develop pain, and long-term follow-up has not always shown a progression to symptomatic tears. (Lippincott Journals)
Why Do These “Abnormalities” Exist Without Pain?
1. Adaptive Changes, Not Always Injury
Repeated overhead throwing (like in pitchers) causes adaptive changes in shoulder structures. These are not always “injuries,” but rather natural adaptations to the stress of throwing. (sogacot.org)
For example, the study in MLB pitchers found that more innings pitched correlated with rotator cuff and labral changes — suggesting that these are wear-and-adapt changes, not acute injury. (Ovid)
2. Imaging ≠ Pain Generator
Just because there is a tear or degeneration on MRI does not necessarily mean that’s what’s causing pain. Many of these changes are “silent” — they don’t cause symptoms.
As the review points out, imaging findings often have poor correlation with pain or future injury risk, especially in high-level throwers.
3. Long-Term Stability
In some athletes, “abnormal” findings remain stable over years without causing clinical problems. For example, in a long-term follow-up study, many throwers with partial or full-thickness tears on MRI did not go on to require surgery or develop significant symptoms.
Why This Stuff Matters for Patients and Clinicians
Scans Should Be Interpreted in Context: For a throwing athlete, abnormal imaging doesn’t always mean a surgical problem. Clinical evaluation (symptoms, strength, function) is far more important than imaging alone.
Treatment Should Be Individualized: Even if imaging looks “bad,” many athletes can remain pain-free with appropriate loadmanagement, strength training, and movement retraining.
Reducing Fear: Explaining to patients that imaging changes are common—even in elite athletes who throw a lot—can reduce fear, anxiety, and “scan catastrophizing.”
Bottom Line (With Research-Backed Insight)
Yes, many elite throwers and overhead athletes have MRI abnormalities like rotator cuff tears, labral changes, or bursitis — but they frequently don’t have pain.
These changes may reflect adaptation, not injury.
Clinical decisions should weigh function, symptoms, and goals, not just what a scan shows.
