MRI is often something that many of my patients request when coming to see me.  We have access to fantastic facilities to obtain MRI and our rates are better than the industry standard.  BUT, is there a need for this when looking at the shoulder?

A recent study by Barreto, et al; 2019, reported that the incidence of findings in MRI of the shoulder are just as common in the non-painful shoulder as they are in the painful shoulder (of the same person!).

What do you mean!?

Well, the study was set up in the following way;

“123 individuals (246 shoulders) with chronic intermittent unilateral shoulder pain (pain located on one side only) for 35.8 months on average since first onset, participated in this study. The average age of the participants was 39.4 years with 15 individuals aged 60 years or older, and 66 participants were men”

MRI was taken of both shoulders and the results showed that only for a full thickness tear and shoulder OA were there clear differences in each shoulder.  This means that those who had a rotator cuff tendinopathy likely had the same changes under imaging on the other shoulder BUT had no pain.  How can we explain this then?

Well to start with, the obvious thing to say is that maybe the injury that is showing is not actually a cause of pain – but something must be the cause surely!?  Well, this is true, but being able to single handily prove this is beyond difficult!

The authors actually partly concluded the following;

“Our investigation questions the clinical utility of MRI for treatment planning because a high prevalence of alterations in asymptomatic shoulders was observed. This finding indicates that although MRI can accurately identify tissue pathology, it cannot discriminate whether that altered anatomy is associated with specific clinical findings. This is of particular importance to physicians, surgeons, and physical therapists who might use the MRI findings to guide the decision toward a treatment plan.”

How does this affect our approach to care though?

If I am honest, it doesn’t really change things for me.  There is a saying that I stand by which goes ‘treat the (wo)man and not the scan’ – meaning that the scan does not direct my approach, the patient in front of me does.  For example, I recently had a patient who had shoulder pain and wanted an MRI but we discussed the reasons for it and the reason stemmed around so that we ‘knew we wouldn’t be damaging anything’.  I then explained to them that we would never work in areas where we may damage something and that is why the MRI for me is not needed.  At the end of the day, if an activity or intervention hurts then I will not ask you to do it, no matter how ‘good’ it is for the body!

MRI does have its place though but this is usually further down the line of treatment if things are not getting better.  There is some controversy to this though as sometimes you can be met with patients asking why they did not get this done sooner, but if we sent everyone for MRI straight away then the financial costs would be way too high for people to manage with.  I understand it is a risk but for the number of times we get it slightly incorrect, much of the time we are correct in our diagnosis and management that it is not worth changing our approach just yet.  And this piece of research only helps to justify this standpoint.

So, if you are suffering from a shoulder injury then why not visit us and get it checked out.  We will take a thorough assessment of the region and form a plan to get you back to being your best.