MRI Findings in Asymptomatic Climbers’ Shoulders: When “Abnormal” Is Normal
MRI Findings in Asymptomatic Climbers’ Shoulders: When “Abnormal” Is Normal
One of the most persistent problems in climbing medicine is not injury itself—it is interpretation. Imaging, particularly MRI, is frequently treated as a definitive diagnostic tool rather than what it actually is: a high-resolution description of tissue morphology at a single time point, disconnected from load tolerance, adaptation history, or symptom behavior.
A 2022 study out of the Steadman Philippon Research Institute directly addresses this issue by examining MRI findings in asymptomatic elite-level rock climbers. The results are striking, and for clinicians, coaches, and serious climbers, they should fundamentally recalibrate how shoulder MRIs are interpreted in this population
Shoulder Pathology on Magnetic …
This paper does not suggest climbers are “injured.” It suggests that climbing—by its very nature—produces structural adaptations that look pathological when viewed through a conventional orthopedic lens.
Study Overview
The authors prospectively evaluated 50 elite climbers (100 shoulders total), all climbing 5.11 or harder for at least five years, with no shoulder pain, no history of dislocation, surgery, or known shoulder injury.
Each participant underwent:
Bilateral 3-Tesla shoulder MRI
Full bilateral shoulder physical examination by sports medicine physicians
Blinded MRI interpretation by two fellowship-trained musculoskeletal radiologists
This design matters. These were not recreational climbers. These were experienced, high-volume athletes who had accumulated years of overhead loading, isometric contraction, and extreme joint positions—without symptoms.
The Headline Results (and Why They Matter)
If you are accustomed to reading MRI reports as indicators of injury, the prevalence numbers in this study are going to feel uncomfortable.
Rotator Cuff and Peritendinous Findings
Rotator cuff tendinosis: 80%
Supraspinatus: 80%
Infraspinatus: 53%
Subscapularis: 18%
Subacromial bursitis: 79%
Long head of the biceps tendinopathy: 73%
These findings were present in shoulders with full strength, full range of motion, and no pain.
From a tissue adaptation standpoint, this should not be surprising. Tendinosis on MRI largely reflects increased signal intensity, collagen disorganization, and fluid content—not failure. In climbers, these tissues are exposed to:
Sustained near-bodyweight isometric contractions
High strain at long muscle lengths
Frequent overhead positioning under load
If anything, the absence of more high-grade tearing is notable. Partial-thickness tears were rare, and full-thickness tears were essentially nonexistent.
Labral Pathology: Common, Non-Specific, and Poorly Correlated
Any labral pathology: 69%
Discrete labral tears: 56%
Most commonly superior labral involvement
Again, these were asymptomatic shoulders.
Labral abnormalities have long been reported in asymptomatic overhead athletes—baseball pitchers, volleyball players, water polo players—and climbers appear to fall squarely into this category. What differentiates climbers is not the presence of labral signal, but the loading environment:
End-range shoulder elevation
Traction-dominant forces
Combined rotation + elevation under sustained load
One of the more interesting findings was that climbers with labral tears actually demonstrated greater forward elevation, both actively and passively. This runs counter to the typical instability or stiffness narrative and instead suggests that time spent at motion extremes may be a primary stressor on the labrum.
In other words, the labrum is likely adapting—and sometimes fraying—under repeated exposure to extreme ranges rather than failing catastrophically.
The Most Important (and Under-Discussed) Finding: Cartilage Changes
This is where the paper becomes genuinely provocative.
Humeral head cartilage changes: 57%
Over half were moderate to severe (Outerbridge grade ≥3)
Glenoid cartilage changes: 19%
The average age of the cohort was 34 years.
This level of glenohumeral cartilage change is not reported in other asymptomatic overhead athlete populations at similar ages. Pitchers, volleyball players, and hockey players do not show comparable rates.
This raises uncomfortable questions:
Are climbers accumulating joint-level shear forces that are underappreciated?
Is sustained hanging plus dynamic movement creating repetitive micro-shear at the articular surface?
Are we systematically underestimating the long-term joint consequences of elite climbing?
The authors explicitly note that instability mechanisms are unlikely—there were no Hill-Sachs or Bankart lesions and no history of instability events. This points instead toward chronic load accumulation, not acute trauma.
From a physiology standpoint, cartilage adapts poorly to repetitive shear, especially under high load and low recovery conditions. Unlike tendon, cartilage has limited regenerative capacity. Whether these MRI findings translate to earlier symptomatic osteoarthritis remains unknown—but ignoring them would be naïve.
Clinical Examination vs MRI: A Reality Check
Despite the overwhelming prevalence of MRI “abnormalities”:
All climbers had full strength
No impingement signs
Minimal tenderness
No instability on exam
Aside from slightly greater forward elevation in those with labral tears, MRI findings did not correlate with physical exam results.
This reinforces a point that cannot be overstated:
MRI findings in climbers have extremely poor standalone clinical relevance.
Imaging without context risks overdiagnosis, unnecessary fear, and inappropriate intervention.
Practical Implications for Climbers, Coaches, and Clinicians
1. MRI Should Not Drive Treatment in Isolation
High-signal tendons, labral fraying, and even cartilage changes may represent training history, not injury. Treating the image instead of the athlete is a mistake.
2. Shoulder Pain ≠ Structural Damage
This study reinforces that pain is not a reliable proxy for tissue pathology, particularly in experienced climbers with high tissue tolerance.
3. Load Management Matters More Than Anatomy
If cartilage changes are accumulating silently, then:
Volume management
Rest exposure
Variation in shoulder loading vectors
Avoidance of chronic end-range hanging under fatigue
may be more important than any single strengthening exercise.
4. Strength and Capacity Still Matter
Strong rotator cuff and scapular musculature likely serve as force distributors, reducing joint-level stress. Avoiding strength training because of “MRI findings” is backward logic.
Limitations Worth Acknowledging
The study lacks a non-climbing control group and uses a 3-Tesla MRI, which may detect more subtle signal changes than older 1.5-Tesla studies. That said, this does not invalidate the findings—it highlights how sensitive imaging has become relative to clinical relevance.
Bottom Line
If you MRI enough elite climbers, you will find pathology—whether it matters or not.
This paper reinforces a necessary reframing:
Structural changes are common
Symptoms are optional
Imaging is descriptive, not diagnostic
For climbers, shoulders adapt aggressively to extreme demands. The question is not whether MRIs will look abnormal—but whether training, recovery, and long-term exposure are being managed in a way that preserves function over decades, not just seasons.
That is a far more important problem than any single MRI report.
Cooper JD, Seiter MN, Ruzbarsky JJ, Poulton R, Dornan GJ, Fitzcharles EK, Ho CP, Hackett TR. Shoulder pathology on magnetic resonance imaging in asymptomatic elite-level rock climbers. Orthopaedic Journal of Sports Medicine. 2022;10(2):23259671211073137. doi:10.1177/23259671211073137