Finnish researchers examining 602 adults aged 41-76 with bilateral shoulder MRIs discovered rotator cuff abnormalities in 98.7% of participants, challenging the conventional wisdom that imaging findings correlate with shoulder pain. The population-based study used standardized clinical assessments alongside high-resolution 3-Tesla MRI to classify tendon damage from normal tissue through partial tears to complete ruptures. This finding represents a paradigm shift in understanding shoulder pathology. For decades, clinicians have relied on MRI abnormalities to explain patient symptoms and guide treatment decisions. The near-universal presence of rotator cuff changes across this representative sample suggests these structural alterations may be largely age-related degenerative processes rather than primary pain generators. This has profound implications for clinical practice, potentially reducing unnecessary surgical interventions and redirecting treatment toward functional rehabilitation. The study's strength lies in its population-based design rather than clinic-based sampling, which typically overrepresents symptomatic individuals. However, the age range limits generalizability to younger adults. This research aligns with similar findings in spinal imaging, where disc degeneration often occurs without symptoms, fundamentally questioning how we interpret diagnostic imaging in musculoskeletal medicine.