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Where Does Medical Imaging Fit In….?

It is a common request of people with pain or injury to have diagnostic imaging done, whether it is an X-ray, ultrasound or MRI. Often the physician or clinician will instruct the person to wait before they are sent for these diagnostics. There are good reasons for this approach. Physicians and clinicians are trained to listen and assess for indicators or ‘red flags’ that would identify serious pathologies that would require immediate diagnostics. Often the physician/clinician is able to diagnose the source of the person’s pain and injured structures and direct them to the proper treatment approach without needing diagnostic imaging. If recovery is not occurring as expected the physician or clinician may then consider a diagnostic image to investigate further and alter the treatment.

Another reason to avoid unnecessary medical imaging is that they often report non-clinically relevant changes. These findings are identified as ‘abnormal’ but are actually ‘normal’ changes that occur in the body as we age. These changes include degenerative disc disease or disc bulges, tendon tears or tendinosis, meniscus/cartilage tears and ‘arthritis’. There are a number of studies that show that these changes are often found in ‘asymptomatic’ people who experience no pain or impairment. These image findings may occur in a person who is experiencing pain, but do not necessarily explain their pain. Unfortunately studies have shown that people who are told of these non-clinically relevant findings have added mental/emotional stress as well as longer lasting pain and disability.

If your clinician does not seem overly concerned or explains that your diagnostic findings are not clinically significant to your current condition, do not be insulted. They are not saying that they don’t believe you are in pain. What the clinician may be telling you is that the findings could be part of normal aging and often found in people who are fully functional and painfree. The pain or dysfunction that you are experiencing in that body area may be influenced by the findings or be caused by something completely different that can be addressed by the proper treatment. If you have questions about your diagnostic images you should ask your clinician but remember the images are only a part of the bigger clinical picture.

Below are some interesting statistics regarding diagnostic findings in ‘Asymptomatic’ people.

Back: Lumbar disc degeneration was found in 40% of participants under the age of 30, and over 90% in people over 50 years of age. Cheung KM, et al. Spine (2009)

Shoulder: In 51 men between the ages of 40-70, 22% had partial rotator cuff tears, 78% had bursal thickening and 96% had other ‘abnormalities’ . Girish et al. AM J Roent (2011)

Knee: ‘Arthritic’ findings have been shown to be present in the majority of adults (approx. 85%) even though they experience little or no knee pain Bedson J, Croft PR. BMC Musculoskeletal Disorder (2008)

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