MRI findings in patients with scapular pain, such as C5-6 pathology and supraspinatus tendinopathy, frequently overlap with normal age-related changes in the general population, requiring careful clinical interpretation within appropriate context.
- The most prevalent MRI findings in scapular pain patients were supraspinatus tendinopathy (88%), C5-6 foraminal stenosis (66%), and C5-6 degenerative changes (65%)
- All major imaging findings showed significant associations with age (p < 0.01), but not with sex or pain laterality
- Study included 503 patients from 2015-2025, with 284 undergoing MRI of cervical spine, thoracic spine, shoulder, or scapula
- Incidental MRI findings increase with age, meaning imaging abnormalities in scapular pain patients should be interpreted cautiously within clinical context
- Researchers called for prospective studies with standardized MRI protocols to better determine clinical utility of imaging in scapular pain diagnosis
MRI findings in patients with pain in the shoulder blade overlap with findings that occur in the general aging population, according to research published October 16 in Interventional Pain Medicine.
A team led by Chetan Potu, MD, from Stanford University in California reported C5-6 pathology and supraspinatus tendinopathy to be the most prevalent imaging findings in patients with scapular pain.
“Incidental MRI findings in the spine and shoulder increase with age, and therefore MRI findings in patients with scapular pain should be cautiously interpreted within appropriate clinical context,” the Potu team wrote.
Scapular pain can stem from multiple sources, meaning accurate identification of the pain source is needed for appropriate interventional strategies. And while clinical history and physical exams are used to determine primary sources of pain, MRI may be called upon for isolated scapular pain that does not improve over time.
Potu and colleagues noted a lack of data on when clinicians decide to order MRI, which MRIs are ordered, and what imaging abnormalities are commonly identified. The researchers studied the prevalence of imaging findings in these patients.
The study included 503 patients at a single center from 2015 to 2025 who presented to orthopedic clinics with scapular pain. Of these patients, 284 underwent at least one MRI exam, which included the following areas: cervical spine (n = 203), thoracic spine (n = 76), shoulder (n = 106), and scapula (n = 22).
“While the reason for additional imaging was not assessed in the present study, it is possible that the imaging findings from the first MRI did not sufficiently explain the etiology of the scapular pain, or that treatment of that anatomic region did not improve the scapular pain,” the researchers wrote.
The team identified the following most prevalent findings: were supraspinatus tendinopathy (88%), C5-6 foraminal stenosis (66%), and C5-6 degenerative changes (65%).
These findings showed significant associations with age (p < 0.01 for all), but not sex. This finding supports prior studies showing that the prevalence of supraspinatus tendinopathy and rotator cuff disease prevalence increase with age, the researchers wrote.
The least common findings included scapulothoracic bursitis (0%) and thoracic spine degenerative changes (0% to 7%).
Finally, the team observed no associations between the laterality of scapular pain and the laterality of cervicothoracic spine findings.
The study authors called for prospective studies with standardized MRI ordering and interpretations. They added that such studies could determine clinical utility of imaging in patients with scapular pain.
Read the full study here.
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