Clinical examination for shoulder conditions is not perfect. For that reason MRI tends to be accepted as the ‘gold standard’ and operative decisions may be based more on the MRI than the clinical findings. This has led to inappropriate treatment including unnecessary operations.

MRI's are not perfect either. Normal variations and abnormalities in asymptomatic people must be considered.

Clinical examination by a combination of tests can make MRI unnecessary or determine whether MRI abnormalities are relevant. This paper concentrates on rotator cuff tears.