Original Article| Volume 28, ISSUE 2, P339-345, March 2023

Signal intensity on MRI after conservative treatment of patients with full-thickness rotator cuff tears: Correlation with shoulder pain

Published:January 08, 2022DOI:



      High signal intensity (HSI) on T2-weighted or fat-suppressed magnetic resonance imaging (MRI) around the shoulder is often observed in patients who have a rotator cuff tear, and is generally recognized as an indicator of shoulder pain, especially pain at night. We hypothesized these HSI volumes are reduced after improvement of symptoms. We sought to compare HSI before and after conservative treatment, and to determine if HSI is associated with the patient's pain status over time.


      We enrolled 55 patients (average age 65 years) into the study. All the patients complained of pain at night (University of California, Los Angeles (UCLA) pain score ≤2, Japanese Orthopedic Association (JOA) pain score ≤10) at their initial visits and underwent conservative treatment. MRI was obtained at their initial visit and after improvement of pain when their initial UCLA pain score was ≥6 points or JOA pain score was ≥20 points. The mean time between the MRI examinations was 11.8 months (SD 7.7) (range 2.5–39). HSI was assessed at the location of the subacromial–subdeltoid bursa, glenohumeral joint, subcoracoid bursa, and sheath of the long head of the biceps tendon, and graded. Factors correlating with the improvement of MRI findings were evaluated retrospectively.


      HSI had improved in 30 shoulders in all or some of the locations (I-group). There was no change in 25 shoulders for any location or aggravation in one or more locations (N-group). Multivariate logistic regression analysis found that the time from pain improvement until the second MRI was the only independent factor related to the improvement in HSI (p = .045).


      Improvement of shoulder symptoms is not directly associated with MRI findings. Improvement in HSI followed symptom improvement after a delay; the changes varied for each shoulder location.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Orthopaedic Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ainsworth R.
        • Lewis J.S.
        Exercise therapy for the conservative management of full thickness tears of the rotator cuff: a systematic review.
        Br J Sports Med. 2007 Apr; 41: 200-210
        • Baydar M.
        • Akalin E.
        • El O.
        • Gulbahar S.
        • Bircan C.
        • Akgul O.
        • et al.
        The efficacy of conservative treatment in patients with full-thickness rotator cuff tears.
        Rheumatol Int. 2009 Apr; 29: 623-628
        • Boorman R.S.
        • More K.D.
        • Hollinshead R.M.
        • Wiley J.P.
        • Mohtadi N.G.
        • Lo I.K.Y.
        • et al.
        What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears.
        J Shoulder Elbow Surg. 2018 March; 27: 444-448
        • Goldberg B.A.
        • Nowinski R.J.
        • Matsen F.A.
        Outcome of nonoperative management of full-thickness rotator cuff tears.
        Clin Orthop Relat Res. 2001 Jan; : 99-107
        • Itoi E.
        Rotator cuff tear: physical examination and conservative treatment.
        J Orthop Sci. 2013 Mar; 18: 197-204
        • Kijima H.
        • Minagawa H.
        • Nishi T.
        • Kikuchi K.
        • Shimada Y.
        Long-term follow-up of cases of rotator cuff tear treated conservatively.
        J Shoulder Elbow Surg. 2012 Apr; 21: 491-494
        • Kukkonen J.
        • Joukainen A.
        • Lehtinen J.
        • Mattila K.T.
        • Tuominen E.K.J.
        • Kauko T.
        • et al.
        Treatment of non-traumatic rotator cuff tears: a randomized controlled trial with one- year clinical results.
        Bone Joint Lett J. 2014 Jan; 96-B: 75-81
        • Tanaka M.
        • Itoi E.
        • Sato K.
        • Hamada J.
        • Hitachi S.
        • Tojo Y.
        • et al.
        Factors related to successful outcome of conservative treatment for rotator cuff tears.
        Ups J Med Sci. 2010 Aug; 115: 193-200
        • Fucentese S.F.
        • von Roll A.L.
        • Pfirrmann C.W.A.
        • Gerber C.
        • Jost B.
        Evolution of nonoperatively treated symptomatic isolated full-thickness supraspinatus tears.
        J Bone Joint Surg Am. 2012 May; 94: 801-808
        • Jung W.
        • Lee S.
        • Hoon Kim S.
        The natural course of and risk factors for tear progression in conservatively treated full-thickness rotator cuff tears.
        J Shoulder Elbow Surg. 2020 Jun; 29: 1168-1176
        • Kwong C.A.
        • Ono Y.
        • Carroll M.J.
        • Fruson
        • More K.D.
        • Thornton G.M.
        • et al.
        Full-thickness rotator cuff tears: what is the rate of tear progression? :A systematic review.
        Arthroscopy. 2019 Lan; 35: 228-234
        • Mall N.A.
        • Kim H.M.
        • Keener J.D.
        • Steger-May K.
        • Teefey S.A.
        • Middleton W.D.
        • et al.
        Symptomatic progression of asymptomatic rotator cuff tears: a prospective study of clinical and sonographic variables.
        J Bone Joint Surg Am. 2010 Nov; 92: 2623-2633
        • Maman E.
        • Harris C.
        • White L.
        • Tomlinson G.
        • Shashank M.
        • Boynton E.
        Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging.
        J Bone Joint Surg Am. 2009 Aug; 91: 1898-1906
        • Moosmayer S.
        • Gartner A.V.
        • Tariq R.
        The natural course of nonoperatively treated rotator cuff tears: an 8.8-year follow-up of tear anatomy and clinical outcome in 49 patients.
        J Shoulder Elbow Surg. 2017 Apr; 26: 627-634
        • Safran O.
        • Schroeder J.
        • Bloom R.
        • Weil Y.
        • Milgrom C.
        Natural history of nonoperatively treated symptomatic rotator cuff tears in patients 60 years old or younger.
        Am J Sports Med. 2011 Apr; 39: 710-714
        • Yamamoto N.
        • Mineta M.
        • Kawakami J.
        • Sano H.
        • Itoi E.
        Risk factors for tear progression in symptomatic rotator cuff tears: a prospective study of 174 shoulders.
        Am J Sports Med. 2017 Sep; 45: 2524-2531
        • Hirano Y.
        • Sashi R.
        • Izumi J.
        • Itoi E.
        • Wataraiet J.
        Comparison of the MR findings on indirect MR arthrography in patients with rotator cuff tears with and without symptoms.
        Radiat Med. 2006 Jan; 24: 23-27
        • Moosmayer S.
        • Tariq R.
        • Stiris M.G.
        • Smith H.-J.
        MRI of symptomatic and asymptomatic full-thickness rotator cuff tears: a comparison of findings in 100 subjects.
        Acta Orthop. 2010 Jun; 81: 361-366
        • Machida A.
        • Sugamoto K.
        • Miyamoto T.
        • Inui H.
        • Watanabe T.
        • Yoshikawa H.
        Adhesion of the subacromial bursa may cause subacromial impingement in patients with rotator cuff tears. Pressure measurements in 18 patients.
        Acta Orthop Scand. 2004 Feb; 75: 109-113
        • Santavirta S.
        • Konttinen Y.T.
        • Antti-Poika I.
        • Nordstrom D.
        Inflammation of the subacromial bursa in chronic shoulder pain.
        Arch Orthop Trauma Surg. 1992; 111: 336-340
        • Sigholm G.
        • Styf J.
        • Körner L.
        • Herberts P.
        Pressure recording in the subacromial bursa.
        J Orthop Res. 1988; 6: 123-128
        • Borick J.M.
        • Kurzweil P.R.
        Magnetic Resonance Imaging appearance of the shoulder after subacromial injection with corticosteroids can mimic a rotator cuff tear.
        Arthroscopy. 2008 Jul; 24: 846-849
        • Major N.M.
        MR imaging after therapeutic injection of the subacromial bursa.
        Skeletal Radiol. 1999 Nov; 28: 628-631
        • Bergman A.G.
        • Fredericson M.
        Shoulder MRI after impingement test injection.
        Skeletal Radiol. 1998 Jul; 27: 365-368