ObjectivesElite overhead athletes, such as volleyball players, are predisposed to shoulder injuries due to repetitive overhead movement and overloading of the shoulder joint and surrounding muscles and ligaments. Returning to play at an elite level following shoulder surgery is often not possible. We hypothesised that MRI of elite volleyball players’ dominant shoulders would demonstrate extensive asymptomatic shoulder pathology that does not prevent the athlete from competing. To test this hypothesis, the objective of this observational study was to evaluate the history, physical examination and MRI findings to determine the incidence of asymptomatic shoulder pathology. We believe this knowledge will improve outcomes in the management of shoulder pain in overhead athletes and prevent unnecessary surgical procedures.Methods26 asymptomatic elite volleyball players of the US Men’s and Women’s National Indoor Volleyball Teams underwent MRI (0.27 Tesla) of their dominant shoulders and physical examinations of both shoulders. Asymptomatic was defined as being able to play volleyball without restrictions. The imaging was reviewed by two fellowship-trained musculoskeletal radiologists. Visual Analogue Pain scores, range of motion, strength, University of California, Los Angeles and American Shoulder and Elbow Society outcome scores were measured and recorded.ResultsThe mean age at the time of MRI was 25.53 years old (range: 21 to 30 years). There were 14 male and 12 female players. 23 athletes had rotator cuff tendinosis (88.5%) and 17 athletes had partial rotator cuff tears (65.4%). 13 of these tears involved the supraspinatus with five moderate-to-high-grade and eight moderate-to-low-grade. Two tears involved the infraspinatus, and there were two subscapularis tears. Six athletes had a labral tear (23.1%) and six additional athletes had labral fraying (23.1%). All MRIs showed abnormal pathology.ConclusionThese findings support the notion that elite-level volleyball players display asymptomatic shoulder joint pathology in their dominant arm, particularly of the rotator cuff and labrum, which do not limit their ability to participate.Level of evidenceV