This is a question I get asked almost daily when seeing patients and I wanted to use this as an opportunity to suggest when you should and when you shouldn't get a scan.
Knee pain can be cause by a number of factors. To name a few, we have patella tendinitis/tendinosis, osteoarthritis, meniscus degeneration/tears, bone spurs, ligament injury, ITB pain, the list goes on. But being able to decide when to get a scan is usually quite straight forward.
I had an interesting meeting with group of consultants just the other day and their views were that they scan ALL knees when they come in. The difference here though is that most people seeing the orthopaedic consultants have sustained a traumatic injury which bought on immediate pain. It is rare for those with a grumbling knee pain, or one that has been there for a prolonged time period, to go straight to see an orthopaedic surgeon. So there reasoning for performing scans almost all the time is because they almost always see traumatic injuries (whether they are high trauma such as a car crash or low trauma such as a fall onto the knee). The point being here though is that ALL trauma injuries should be scanned.
And I follow this mantra too. But how do you determine real trauma. Well there are some cardinal signs of trauma and they usually include the following;
- Immediate swelling or swelling within 24 hours
- A 'moment' of injury (be it impact or from a twist/fall)
- High levels of pain (usually – but important to note not always, you can have trauma with little pain)
So if any of these occur then my advice would be to scan the knee so we can find out exactly what is happening. It will also enable us to know exactly what structure we are treating and whether or not we can manage this conservatively. This is where our links with orthopaedic consultants is so vital. These decisions are often a shared decision based on their opinion, us as the treating therapist but also, and most importantly, you as the patient. Your decision is the one that matters most here and how you want to proceed, we can only help, advise and guide you through the process by giving you the best information possible.
So when would I not recommend a scan? The obvious answer here is when there is no evidence of trauma. Whilst this is a black and white view point, there are certainly some grey areas to this statement. First, when there are no signs of trauma then we may be dealing with an overuse injury or a situation where the joint cannot cope with the load it is being asked to carry out. If this is the case then a specific management plan for your knee will be developed and we monitor the progress from here.
In some case we have degenerative situations occur. This is usually in the meniscus area and happens over time, usually due to abnormal loading patterns BUT can also be genetically based. We now know that there is poor evidence that surgical operation leads to better outcomes. Most good orthopaedic surgeons will now advise against operation in the first instance BUT it may be a thing to do later on. The aim always is to preserve the meniscus for as long as possible. So attempting conservative management should be your first option here. And it is in these cases where a scan is not needed. If the progress does not go as planned and we have exhausted all avenues, then we may suggest a scan to see if we are missing something and to help re-align our focus. The argument here is 'well why do I not just get a scan from the beginning' has some element of truth, but if we can save on the cost of this then why not. Obviously, if everyone wanted to get a scan they could, but its weighing up the benefits which is the purpose of the point I am making here.
We also never advise scans for Osteoarthritis. The reason is because Osteoarthritis is a clinical diagnosis and not a radiological one. This means that your symptoms determine if you have Osteoarthritis or not. For example, someone may have images which show no joint space, 'bone on bone', etc…. but have NO pain. On the other hand, someone may show bigger joint space on imaging but have A LOT of pain. This is why we say the diagnosis is clinical and not radiological. This is important to be aware of as it can lead to really bad outcomes for the patient if they do not follow this guidance.
So that is a very generic overview of when I would suggest a scan vs when I would not. Obviously, the patient's preference is key here and I would never stop anyone from doing it. In an ideal world it would be great to be able to offer scans to everyone BUT there are limitations to this. We have seen studies before that show people with no pain in their knees presenting with tears of meniscus, ligament damage, all high level structural changes….yet have NO Pain. The fear then is we start to treat something which is in fact not the issue and if it does not get better they may end up having surgery on something which is in fact totally normal for them! So be cautious with those scans.
If you are suffering from knee pain then why not see one of our team members here who can help assess, diagnose and treat your pain with a specific rehab plan to get you back to being pain free again.
