Many patients will ask for a scan expecting to find the answers to their pain. Imaging can show bone, ligaments, tendons, nerves, and many other tissues but does it show us pain? Sure, scans may not provide all the answers but there can’t be any harm in using them, right? This blog with look into scans and imaging from a musculoskeletal perspective and discuss why your scan does not always paint the full picture.
Yes, they are definitely useful. Imaging can help confirm a suspected diagnosis that requires more serious intervention such as a fracture, ACL rupture or serious cartilage injury. A scan can also rule out more serious pathology and red flags such as some types of cancer. Musculoskeletal imaging has a very useful place in the medical world, it is just that it can be unnecessary and often overused.
Pain, the main driver for why people seek out medical help and many people will expect some sort of imaging to show the source of their pain. Unfortunately, this is not the case. X-rays, ultrasounds, MRIs all show anatomy. They do not show pain, they show different structures such as bone, ligaments, and discs. Some may argue that what if an MRI shows a bulging lumbar disc, should this not be the source of the pain? Recent research begs to differ. A study by Brinjiki et al (2015) did an MRI on 3110 pain free individuals. The found in these pain free people, those aged in their 40’s, 68% had disc degeneration and 50% had a disc bugle. Changes were also found in people in their 20s, with 37% having disc degeneration and 30% having a disc bulge. All the people in this study were considered pain free even with the imaging showing anatomical changes. This suggests that normal changes occur as we age and that there is a poor correlation between changes in our anatomical structures and pain. This highlights why every image and scan should be taken with a grain of salt, it may show some change to your anatomy but how do we know that the change hasn’t been there for years and you have been pain free.
Physically speaking there is minimal risk, some scans do give off radiation, but a one-off image should not cause any issue. Scans can be harmful in another way, without the proper explanation and context, they can cause fear and apprehension around movement and doing more damage to their injury. So many times in the clinic, a patient will come in and say they were told they had a disc bulge 10 years ago therefore have must avoid all bending and lifting activities cause they don’t want to cause more damage to their back. This happens all to often and not just with backs but knees, shoulders, hips, necks, to name a few. Patient have been told in the past that a scan showed changes, so they avoid activities out of fear of further damage. The scans these people had did not cause any physical damage but the misinformation they took from them has potentially limited their ability to live a more enjoyable life.
The takeaway from this blog is that scans can be very helpful when used in the right context but they can also show us changes that are normal age related changes to our body. Every scan should be explained so a patient understands that anatomical changes are normal and may not be the cause of their pain.