Getting the results from your xray or MRI can be overwhelming, especially when your health care professional does not explain the findings in the context of what is ‘normal’. Terms like ‘disc bulges’, ‘degenerative change’ or ‘disease’ and ‘cartilage tears’ can be scary things to hear!
Over the past decade, several imaging studies have taught us that many of these pathological findings previously found in people experiencing pain are also present in the pain-free population.
So, we may not need to worry about these things as much as we thought…and they may not even be related to what’s actually causing the pain!
But don’t just take my word for it, let’s dive into some of the research surrounding this topic.
Hopefully this will help to de-threaten some of the scary terms you may have heard in your own imaging results.
The Neck and Shoulder
Let’s start with the neck and make our way down. Historically, ‘disc bulges’ have been villainised and often labelled as the source of pain.
As it turns out though, disc bulges in the neck are common in people with no neck pain too.1 A large-scale study (N1211) in 20151 found that 87.6% of the asymptomatic subjects had significant disc bulges in their cervical spines. This number did increase with age, but the numbers were high even for subjects in their 20’s, with 73.3% of males and 78% percent of females having disc bulging.
What about the shoulder then? Well, research has found that as much as 96% of asymptomatic(pain-free) shoulders have abnormalities including subacromial-subdeltoid bursal thickening, AC joint osteoarthritis and supraspinatus tendinosis according to ultrasound scan results2.
Confusing…. I know.
The Low Back
Low back pain is the most common musculoskeletal complaint that we see in the clinic and here is a great example of why MRI scans do not always give us the answers we are looking for.
A huge systematic review was published in 2015 by Brinjinki and colleagues3 which included 3110 asymptomatic individuals. They investigated several pathologies commonly reported on lumbar MRI scan including disc degeneration, disc signal loss, disc height loss, disc bulge, disc protrusion, annular fissure, facet degeneration and spondylolithesis. I won’t discuss all the findings at length here, but I would urge you to read this paper in full if you are interested in finding out more on these pathologies. They found that ‘disc degeneration’ was present in 37% of healthy, symptom-free 20-year old and this number increased to 52% by aged 30. Furthermore, lumbar ‘disc bulges’ were present in 30% of healthy, symptom-free 20 year old’s and increased with age to 60% in 50 year old’s and 84% in 80 year old’s.
The Hip and Knee
Labral tears have previously been reported in 68.1% of pain-free hips4 and in subjects >40 years-old, osteoarthritis has been found in 19-43% of pain-free knees.5
Finally, another study in 20206 found that nearly all (97%) of the uninjured 230 knees (median age 44) they investigated, had abnormalities on MRI and 30% of these had meniscal tears.
It is important to understand that a number of abnormalities found on scans are a normal part of aging and are not necessarily related to your pain symptoms. This is not to say that they are never related, but we need to ensure that the clinical presentation is aligned with the imaging findings and consider the possibility that any ‘abnormalities’ could be incidental and unrelated.
Now, don’t get me wrong, at times diagnostic imaging including MRI scans and ultrasound can be essential diagnostic tools, especially to rule out serious pathology and to determine if further interventions are indicated. However, many pathologies found on imaging are often poorly correlated to symptoms and are too often blamed as the source of the problem. Additionally, when these findings are explained to the patient without context of what is ‘normal’, this can lead to fear avoidance behaviour, longer recovery times and at worse, unnecessary surgical interventions.
The moral of the story: Don’t get too worried if you saw some of these findings on your imaging results. If you are interested in discussing your results further, please don’t hesitate to get in contact with us and we would be happy to help you make sense of your results in a Physiotherapy assessment in the clinic or, if needed, direct you to the most appropriate health care professional to best help you.
Author: Sam Bellhouse, Registered Physiotherapist.
1: Nakashima, H. et al. 2015. Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine. 15;40(6):392-8.
2: Girish, G. et al. 2011. Ultrasound of the shoulder: asymptomatic findings in men. American Journal of Roentgenology Oct:197(4):W713-9.
3: Brinjikji, W. et al. 2015. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology Apr;36(4):811-816.
4: Frank, J, M. et al. 2015. Prevalence of Femoralacetabular impingement imaging findings in asymptomatic volunteers: A systematic review. Arthroscopy. Jun:31(6):1199-204
5: Culvenor, A, G. et al. 2019. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. British Journal of Sports Medicine. Oct;53(20);1268-1278
6: Horga, L, M. et al. 2020. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiology. Jul;49(7):1099-1107