In this blog, we talk about the usefulness of imaging. We use a study on shoulder ultrasound to illustrate the point – you must take great care when making conclusions from imaging on its own.
Imaging makes so much sense...
Shoulder ultrasound is a very common diagnostic test in musculoskeletal medicine.
The purpose of medical imaging is often to identify an ‘abnormality’, as they have been assumed to be the cause of pain or limitation in movement.
Medical imaging can provide more information about the condition of various tissues but how and when is this relevant?
It is now so advanced and continuing to improve that the level of detail in scans in phenomenal. It is maybe not so surprising that lots of us actually have findings on imaging!
The problem with diagnostic shoulder ultrasound
One study which performed a diagnostic shoulder ultrasound on participants aged between 40-70 years of age found that 96% had abnormal findings. Ninety-six percent!
Some of these findings included:
- rotator cuff tears
- bursal thickening
- calcification and
- osteoarthritis.
The punchline is that all participants who had a shoulder ultrasound were 100% asymptomatic and pain-free.
So what does this actually mean?
Findings on imaging do not mean you have to have pain.
Many of the changes on imaging can be a normal part of ageing – like grey hair (or no hair – editor’s note).
Take home message
You are not your scan. Physiotherapists treat people not scans.
Imaging is important in some situations to rule out sinister pathology or to help determine when surgery may be indicated.
However, imaging on its own doesn’t explain why some people have restricted or painful movements.
Before you go to your GP to get a shoulder ultrasound or think about have a rotator cuff repair, it is worth having an experienced physiotherapist assess your problem.
It may well save you a lot of time, money and frustration down the track!
Reference
Girish, G, Lobo, L, Jacobson, J, Morag, Y, Miller, B & Jamadar, D 2011, ‘Ultrasound of the shoulder: Asymptomatic findings in men’, American Journal of Roentgenology, Vol. 197, no. 4, pp. 713-719.
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