Don’t Let Medical Imaging Get You Down!

In today’s day and age, medical imaging technology is better than ever before.  We have x-rays, ultrasounds, CT scans, MRIs, bone scans, and the list goes on.  Indeed, technology now allows us to visualize internal changes within our joints and soft tissues.  We can detect if the rotator cuff tendons in your shoulder have been torn, if the discs in your back are bulging, and if osteoarthritis has developed in your joints.  So, with all of this available, why are medical professionals often hesitant to refer you for imaging?

Part of it is time and money.  Most of us already know that medical imaging is costly to our health care system.  Additionally, wait times for imaging can be painfully long.  Consequently, to save healthcare dollars and avoid bogging down the system with any unnecessary referrals, physicians are tasked with only referring those who truly need imaging.  But there is more to it than saving money and keeping wait times down.  In some cases, imaging is just not needed nor helpful.

Now, make no mistake, medical imaging is invaluable in cases where we need to rule out serious injury or disease, such as fracture, dislocation, severe third degree tears, and malignancy.  Your medical team relies on this information to make decisions such as whether you need something like casting or surgery, additional tests, or referral to a specialist.  However, in the absence of anything serious, medical imaging is often not necessary and may actually be detrimental in some cases as imaging results may not be clinically relevant.

The fact is, there is poor correlation between imaging findings and clinical presentation.  This means that how bad something looks on imaging does not always dictate how much pain or restriction the patient will experience.  A patient with severe osteoarthritic joint changes on x-ray may have minimal pain and stiffness while a patient with minor changes may be significantly impaired.  Additionally, a lot of asymptomatic people have positive findings on imaging.  For instance, a 2014 study published in the American Journal of Neuroradiology demonstrated that when individuals with NO back pain were put through a CT scan or MRI, a startling percentage were shown to have disc degeneration and disc bulging.  In 20 year olds, the number was 1 in 3.  By 50 years of age, 80% had disc degeneration and 60% had disc bulging – and again, these were people with NO back pain.

This phenomenon is not limited to the back.  In the shoulder, MRI studies have shown that in those 60 years and older with NO shoulder pain, 50% had rotator cuff tears that they were not aware of.  This occurs in other areas of the body as well. 

So, if degenerative changes and tears can be present without pain or dysfunction, then these findings must be interpreted with caution.  Their presence may just be an incidental finding and they do not necessarily dictate why you are having pain nor your prognosis.

Additionally, if the results of medical imaging are not likely to change your medical management, it’s sometimes better not to know.  Studies have shown that once someone has been given a label of abnormal findings (which may in fact be irrelevant), they are more likely to suffer longer duration of pain, more disability, and a poorer sense of wellbeing.  This makes sense.  We hear someone tell us that we have “disc bulging”, “degeneration”, “osteoarthritis”, and so on.  Hearing this can be very scary and can be accompanied by feelings of finality and hopelessness.  These feelings can make us less likely to stay active and seek treatment, which is usually to our further detriment.

If you have had medical imaging that demonstrated findings such as osteoarthritis, tears, or disc bulges, my best advice is to see a Physiotherapist.  These findings may or may not be clinically relevant, but in any case, we can show you what you can do to improve your strength and mobility to help you lead your best life.


Teresa Waser

RX Physiotherapy