Why your “problem” might not be your problem.
Lots of different body regions can hurt (necks, shoulders, elbows, wrists, spines, hips, abdomens, groins, knees, ankles, etc.), and in cases where the discomfort starts limiting our lives, sometimes the next step to be recommended is to get “advanced imaging”.
Advanced imaging is a term that encompasses several different types of tests that give a closer “look” at your problematic area. Diagnostic ultrasound, magnetic resonance imaging (MRI), radiographs (X-Rays), and computed tomography (CT) scans, for example, are all forms of advanced imaging.
But are the things we find on these advanced images considered to be the ‘final word’? And if so, why not simply start with this step from the beginning — tell us exactly where the ‘problems’ are?
Advanced imaging studies
The health field is always looking for new ways to evaluate patient complaints, better methods to find problems, and more efficient ways to treat or rehabilitate injuries. As such, a number of studies have been published regarding the use of advanced imaging, which highlight some of the troubles associated with making diagnostic decisions (ascribing blame to your “problem”) based on the findings.
We have to consider three things (at least) when looking at results from advanced imaging:
- What does the patient consider to be their problem (What are their symptoms)?
- What does the advanced image show us (What is the “finding”)?
- Does the advanced image make sense given what the patient has described (Does the patient complaint match the “finding”)?
This process is important, because people without any symptoms of a problem (they are called “asymptomatic”) may still show signs of a “problem” in the findings of advanced imaging.
For example, in a sample of 39 asymptomatic hockey players (21 professional; 18 collegiate), 36% demonstrated abdominal dysfunction, 64% demonstrated hip joint changes, and overall 77% demonstrated some kind of groin or hip changes on MRI. So 3 out of 4 players have hip or groin “problems” — but no symptoms! In another study, 98 asymptomatic junior elite tennis players had MRIs of their lumbar spines (lower back), which indicated 85% had mild joint degeneration, 62% of players showed some disc degeneration, and 31% demonstrated signs of disc herniation. All of this in asymptomatic athletes — they have no pain!
Need to hear more? A 2013 study from Japan performed diagnostic ultrasound on 664 individuals from a single village to see if they had damaged rotator cuffs (shoulders). 147 of 664 (22%) of the community showed signs of a full-thickness tear — meaning the muscle is completely torn into two pieces. Despite this seemingly gruesome injury, only 34% of these people had symptoms. So 1 in 5 people had a complete tear in their shoulder, but only 1 in 3 of those with tears had any symptoms. Weird or what?
More research is available on this topic (Miniaci et al 2002; Tempelhof et al 1999; Ranson et al 2005), but ultimately what I hope you draw from this is that just because a “problem” or “abnormality” is noted on an advanced image, it isn’t necessarily the cause of your complaint. Most, if not all of us, have some form of imperfection, somewhere, within our body when we look through advanced imaging.
It is still valuable information
Don’t consider these tests a waste of time though! Valuable information can be communicated from advanced imaging — it is simply important that we consider whether or not the findings are likely to contribute to your clinical presentation — how you describe your problem. Though advanced imaging is not a one-stop shop in determining the cause of your pain, when used appropriately it is extremely valuable.
Just because your test results suggest something is “abnormal”, this may not be the cause of your painful complaint(s). Given the high number of “abnormal” findings found by advanced imaging in people without symptoms, health professionals must interpret these results cautiously.
So fear not your “problems” from advanced imaging — it’s possible we’re all in the same boat.
Dr. Jim Gilliard is a chiropractor in Burlington, ON — if you have questions, comments, or wish to book an appointment, contact him at your convenience by leaving a comment below, visiting his website, via email at firstname.lastname@example.org, by phone at (905) 634-6000, or in person at Endorphins Health and Wellness Centre.
- Minagawa H, Yamamoto N, Abe H, Fukuda M, Seki N, Kikuchi K, et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. J Orthop. 2013;10(1):8–12.
- Miniaci A, Mascia AT, Salonen DC, Becker EJ. Magnetic Resonance Imaging of the Shoulder in Asymptomatic Professional Baseball Pitchers. Am J Sports Med. 2002;30(1):66–73.
- Rajeswaran G, Turner M, Gissane C, Healy JC. MRI findings in the lumbar spines of asymptomatic elite junior tennis players. Skeletal Radiol. 2014;43(7):925–32.
- Ranson CA, Kerslake RW, Burnett AF, Batt ME, Abdi S. Magnetic resonance imaging of the lumbar spine in asymptomatic professional fast bowlers in cricket. J Bone Joint Surg Br. 2005;87(8):1111–6.
- Silvis ML, Mosher TJ, Smetana BS, Chinchilli VM, Flemming DJ, Walker E a, et al. High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. Am J Sports Med. 2011;39(4):715–21.
- Tempelhof S, Rupp S, Seil R. Age-related Prevalence of Rotator Cuff Tears in Asymptomatic Shoulders. J Shoulder Elb Surg. 1999;8(4):296–9.