Episode Title
Labral Tears After 40: Why Your MRI Is Lying to You
Podcast
The Three BoneheadsHoward Luks, MD · Jeffrey Berg, MD · Jonathan Hirsch, MD
Episode Summary
If you’re over 40 and have shoulder pain, there’s a very good chance your MRI report mentions a labral tear. And there’s an even better chance that tear has nothing to do with your pain.
In this episode, three experienced orthopedic surgeons unpack one of the most common—and most misunderstood—MRI findings in adult shoulders: superior labral (SLAP) tears. Drawing on decades of surgical experience, they explain why these findings are often age-appropriate, why MRIs frequently create unnecessary fear, and why surgery is almost never the right answer for adults with non-traumatic labral tears.
This is a candid discussion about judgment, restraint, and knowing when not to operate.
Key Topics Covered
1. What the Labrum Actually Is
* A 360-degree ring of tissue around the shoulder socket
* The superior labrum is where the biceps tendon attaches
* Age-related changes are extremely common and often mislabeled as “tears”
2. Why MRIs Overcall Labral Tears
* Most adults over 40 will have a “SLAP tear” reported on MRI
* Radiologists often describe normal age-related changes as pathology
* The word tear creates anxiety and drives overtreatment
* MRI findings frequently don’t correlate with symptoms
3. MRI Quality Matters More Than You Think
* 3-Tesla MRIs are far more accurate than 1.5-Tesla scans for labral pathology
* Contrast (arthrograms) improves detection but is invasive and often unnecessary
* Fellowship-trained musculoskeletal radiologists provide more reliable reads
* Not all MRIs—or interpretations—are created equal
4. When a Labral Tear Actually Matters
* Rare in adults without trauma
* More relevant after:
* Shoulder dislocation or instability
* Clear traumatic events
* Clicking, catching, or mechanical symptoms alone are not enough to justify surgery
5. Why Labral Repairs in Adults Often Fail
* High risk of post-operative stiffness and prolonged pain
* Long recoveries with questionable benefit
* Literature consistently discourages SLAP repairs in patients over age 40
6. What Surgeons Actually Do If They See a Tear
* Most labral findings are ignored during surgery
* Minor fraying may be gently debrided (“a haircut”)
* If the biceps is truly involved and symptomatic, biceps tenodesis is preferred
* True labral repair is exceedingly rare in adults
7. The Real Sources of Shoulder Pain
* Subacromial bursitis
* Rotator cuff tendinopathy (without a tear)
* Age-related tissue changes
* Many people improve without ever identifying a single structural cause
8. Why Time and Re-Examination Matter
* Shoulder diagnoses often evolve
* Multiple visits help clarify what actually provokes pain
* Healing, physical therapy, and patience often outperform early surgery
* Sometimes the pain resolves—and the “diagnosis” never matters
Key Takeaways
* A labral tear on MRI in adults over 40 is usually a normal finding
* The likelihood that it’s causing your pain is close to zero
* The likelihood that you need surgery for it is even closer to zero
* MRIs should inform—not replace—clinical judgment
* Treat the patient, not the picture
Who This Episode Is For
* Adults over 40 with shoulder pain
* Anyone confused or alarmed by an MRI report
* Clinicians navigating imaging-driven anxiety
* Patients told they “need surgery” for a labral tear
Final Word
Sometimes the hardest part of being a surgeon isn’t operating—it’s knowing when restraint, patience, and experience are the better tools. This episode is a reminder that wisdom often means doing less, not more.
