When people are in pain or injured, they often want a scan to “find out” or prove what is wrong with them. However, scans are often not a valid or reliable way to determine the source of your pain. This is because often it is more normal to find pathological findings on scans in asymptomatic people (ie those that are not in pain) than it is to find no pathology.
If you were to take a whole bunch of healthy people and perform investigations including X-Rays, MRI’s, ultrasounds and CT scans on their healthy, pain free joints, chances are you’ll find the same disc bulge, bursitis, labral lesion or cartilage damage that is supposedly the cause of pain in others.
In the research literature, is becoming more and more clear that numerous "injuries" are seen in asymptomatic patients. If someone can have the exact same MRI results as your "bone-on-bone" knee or "disc herniations", but have little or pain, then we have to acknowledge that something else is likely contributing to your individual experience.
Here are some pretty enlightening statistics;
How about the shoulder?
In 51 people without any shoulder pain, 78% of them showed signs of bursal thickening, 65% ACJ degeneration and 39% showed cuff tendinopathy. (Girish et al. 2011). In a separate study on 53 people without any shoulder pain, 72% of people were found to have SLAP lesions (Schwartzberg et al. 2016)
And the Knee?
In 710 people with no knee pain (Guermazi et al. 2012), 68% of individuals were shown to have cartilage damage, whilst 72% had osteophytes.
These high percentages of abnormal findings in people without pain are consistent across nearly every joint in the body
So is getting a scan worth your time and money? Does it help guide your treatment and rehabilitation?
The most usual answer is - No. Unless you have a history of trauma or signs of a sinister pathology, a scan is often a waste of your time and money. MRI’s, X-Rays, ultrasounds and CT scans generally won’t change the way we assess or manage your condition Furthermore, abnormal scan reports can lead you to experience unnecessary anxiety in relation to your symptoms This worry increase your pain and slow down our recovery
It is important to remember that imaging is just a piece of the puzzle in the diagnosis, prognosis and management of an injury/ pain and abnormal findings are often not the CAUSE of an individual’s pain. We treat the individual not the scan!
Brinijiki, et al. 2014, “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.” American Journal of Neuroradiology (2014) 36(4): 811-816.
Girish et al. 2011, “Ultrasound of the shoulder: asymptomatic findings in men” American Journal of Radiology, 197(4): 713-719
Guermazi et al. 2012, “Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study”, BMJ 2012, 345:e5339
Register et al. 2012, “Prevalence of abdnormal hip findings in asymptomatic participants: a prospective, blinded study”, American Journal of Sports Medicine, (2012), 40(12): 2720-4
Schwartzberg et al. 2016, “High prevalence of superior labral tears diagnosed by MRI in middle-aged patients with asymptomatic shoulers’ Orthopaedic Journal of Sports Medicine, 4(1)