Why sometimes a scan result can lead to unnecessary distress, and a poor decision!
We’re very lucky these days that our ability to investigate injuries with scans has become so accessible, so quick, and (in some cases) so cheap. In particular MRI scans have become the “gold standard” scan for many soft tissue injuries. Without doubt the investigative machines and MRI scanners we have at our disposal have become so much better at analysing our body tissues, taking clearer pictures, and sending back beautiful long reports with fancy words attached. The problem is that this advance in technology has become… a problem!
With the abundance of MRI machines around and the ease of availability and referral as mentioned above, there has been much investigation into the millions of scan results so we have a much better idea of what is abnormal finding and what is normal finding – or probably better termed: what is RELEVANT finding and what is NOT RELEVANT!
To explain further, I have taken a few studies that looked at MRI findings in the most common injuries/body parts that tend to present to SSPC. The findings are discussed briefly below, and will no doubt surprise you:
STUDY 1: SHOULDER MRI
- Study of people 123 people between the ages 18 and 77 who had MRI scan due to one painful shoulder (but both shoulders were scanned as comparison)
- 92% had rotator cuff (RC) tendinopathy findings in the painful shoulder, but 88% of them showed RC tendinopathy in the pain free shoulder; 26% of the 123 painful shoulders showed partial thickness RC tears but 20% of the painfree shoulders also had partial thickness RC tears.
- another common finding in MRI scans is “subacromial bursitis” which is like a swollen fluid sac or cyst at the tip of the shoulder. This same study showed that 54% had findings of SA bursitis in the painful shoulder yet 56% (yes, more) had SA bursitis in the non painful shoulder.
- Lastly, AC joint (where your clavicle meets your collarbone) Osteo Arthritis was shown in 91% of painful shoulders and 89% of non painful shoulders.
STUDY 2: LUMBAR SPINE MRI
- Study of the scans of 3110 people aged between 20-80 with NO pain or back issues.
Note that the above graph shows the incidence of “pathology” in ASYMPTOMATIC people -they didn’t even have back pain! Let’s take 50 year olds – 80% of them showed disc degeneration, and 60% showed disc bulges with another 60% showing facet joint degeneration.
STUDY 3: KNEE MRI
- Study of 230 pain free knee MRI’s in 25-75yo people. I’ll keep this one brief and just say that 97% of the symptom free knees scanned showed “abnormalities” varying from meniscal tears to cartilage lesions to tendon and ligament issues. In a nutshell, literally every knee of asymptomatic adults showed abnormalities in at least one knee structure on MRI.
What the above three studies tell us is that “abnormal” findings on MRI are actually very common, and many of these findings happen in people who don’t have pain – so the “abnormal” tissue is NOT causing any pain symptoms. The problem comes if we start interfering (poking, prodding, injecting, operating etc) with this asymptomatic tissue, there’s a fair chance we might make it become symptomatic, and then we have two problems – the original problem and a new pain!
Let me give you a different example to further reinforce the point – if you looked at a photo of me from 30 years ago and compared it to a photo today, you’re going to see some pretty obvious changes in my skin condition (and yes I know – grey hair, more freckles, scars from skin cancers… the list goes on). Just because my skin looks different to how it did 30 years ago doesn’t mean it is not performing the same functions with exactly the same outcomes. And skin is a body tissue the same as tendon and ligament and cartilage and meniscus and bursa are also skin tissues – they just don’t look the same now as they did once upon a time. Just because something doesn’t look right, or doesn’t look like someone else’s does, doesn’t mean it is a problem!
In summary, MRI scans can be brilliant and enormously helpful for many conditions. But the skill lies not so much in reading what is ABNORMAL, but determining what is RELEVANT! So when you read that dreadful list of conclusions on your scans, with words like “bulge” and “tear” and “degeneration” and “full thickness” and the rest of it – don’t despair. Abnormal looking tissue on scan may not bear any relevance to your pain!
Anthony Lance
SSPC Physiotherapist
References available on request
