Musculoskeletal imaging such as MRIs and X-Ray’s are important tools in the diagnosis and screening of serious injuries and conditions. However, overuse of imaging is a current issue in the healthcare system.
We often think a diagnostic image is the best thing for us and will give us all the answers. That’s just not the case. Believe it or not, an XRAY or MRI may find “something” that is present, but it may not be the cause of your pain! What do we mean by this?
Let’s use a rotator cuff tear as an example:
Rotator cuff tears are common in ASYMPTOMATIC people, meaning someone that has no pain, no weakness, no loss of range of motion. When looking at images in this study, more asymptomatic people had rotator cuff tears on an image compared to symptomatic people: 7% versus 4% in 20-29 year-olds and 21% versus 14% in 30 – 39 year-olds. So? Well, this means it can be difficult to determine if that rotator cuff tear that pops up on an image is new OR is actually the cause of symptoms … because it could’ve been there for a few years.
Similarly let’s apply this to low back pain. This review looked at 3110 asymptomatic individuals and established that disc degeneration in the spine was found in 37% of 20 year-olds and 96% of 80 year-olds. Disk herniations (bulge) were seen in 29% of 20 year-olds and 43% of 80 year-olds. Again, all of these people had no symptoms!
For these reasons, research advises AGAINST early imaging for many musculoskeletal conditions.
Image copyright: StartRadiology, Figure 4. Positioning (a) in an apical oblique image (b) <https://www.startradiology.com/internships/general-surgery/shoulder/x-shoulder/>
When is Imaging Recommended?
A recent research article from the British Journal of Sports Medicine states that: Imaging (X-Ray, MRI, CT scan etc.) is discouraged unless:
- Serious pathology is suspected
- There has been an unsatisfactory response to conservative care (physical therapy, medications) or unexplained progression of signs and symptoms
- It is likely to change management
If you do get an image, consider this: since findings of degeneration are common with aging and not necessarily the cause of pain, take into account what your symptoms are and try to determine if it truly matches what is on the X-Ray or MRI.
Disclaimer: This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or decision making for health problems.