Picture this

  • You wake up one morning with shoulder pain, go to see your doctor, and he send you off to get a scan, which quickly reveals you have a “full thickness tear of your rotator cuff”
  • You feel a sharp pain whilst deadlifting, and a scan shows you have a “disc protrusion at L4/5 with foraminal narrowing”
  • You are out for a walk, miss a step, landing on your knee and feel a crack that was painful, and your scan shows that you have a “meniscal tear in your knee”.

What do you do?

‍Most people will ask Dr Google first. Which means very soon you are reading about surgery techniques and recovery time frames whilst worrying about not being able to take that overseas holiday you have booked and paid for in a few week’s time.

Scenarios like these would be familiar to you or someone you know.

Scan results can be very overwhelming and it can be hard to sort through the medical jargon and terminology, to understand what is going on. Unfortunately, sometimes the information obtained from scans can be misleading.

Pain is a wonderfully complex defence mechanism. The purpose of pain is to protect us from physical damage, but damage does not always cause pain, and conversely, pain does not equal damage.

Over the past few years, more and more studies have been conducted to determine the accuracy of scan results and how they pertain to symptomatic individuals. Many studies that have scanned healthy pain free individuals have found that the majority of those people are walking around and functioning normally with some sort of damage or pathology showing up on our scans.

Shoulder

‍A study found 22% of people over the age of 20 had a complete tear of one rotator cuff muscle, and 65% of these had no shoulder pain at all.

That means that you are more than twice as likely to have a tear without pain, than to have a tear with pain!

In a study of elite baseball pitchers with no shoulder pain, 52% had some degree of tear in their rotator cuff, and 61% had a tear in the labrum (fibrocartilage). These high level athletes put an enormous amount of stress on their shoulders each week, half of them have signs of damage on scans, but not one of them have pain!

Knee

‍A study of people aged 50 – 90 years old showed that the rate of meniscal tear increased with age. This study found that 19% of females between 50-60 years old, and 56% of men between 70-90 years old showed meniscal damage, but only 61% of these people had experienced knee pain in the past month!

Back

‍There is a large body of work investigating back scan results in pain free people. The most recent revealed that 37% of pain free 20 year olds, and 96% of pain free 80 year-olds displayed evidence of disc degeneration on their scans. Spine degeneration and disc bulges were also present in a very high proportion of the pain free population.

So what does this mean?

‍Medical imaging can be extremely helpful in aiding diagnosis, but unfortunately, scans will pick up EVERYTHING and will not tell us when the damage occurred or whether it is the direct source for pain.

It is mindful to consider the above study results which have demonstrated that damage can be present without experiencing pain.

Most important, is to step away from Dr Google and consult your health care professional who can conduct a thorough physical examination on the injured site. They will be best placed to be able to determine whether your scan results correlate with your symptoms.

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References
‍Minagawa, H., Yamamoto, N., Abe, H., Fukuda, M., Seki, N., Kikuchi, K., … & Itoi, E. (2013). Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: from mass-screening in one village. Journal of orthopaedics, 10(1), 8-12.
Lesniak, B. P., Baraga, M. G., Jose, J., Smith, M. K., Cunningham, S., & Kaplan, L. D. (2013). Glenohumeral findings on magnetic resonance imaging correlate with innings pitched in asymptomatic pitchers. The American journal of sports medicine, 41(9), 2022-2027.
Englund, M., Guermazi, A., Gale, D., Hunter, D. J., Aliabadi, P., Clancy, M., & Felson, D. T. (2008). Incidental meniscal findings on knee MRI in middle-aged and elderly persons. New England Journal of Medicine, 359(11), 1108-1115.
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., … & Wald, J. T. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816.