x-ray

Do I need an X-ray of my spine?

What about a scan of my shoulder?

Do I need an X-ray? This is one of the most common questions asked in the clinic. Most of the times the answer is no, if you want to learn why, read the blog below.

People suffering pain want to know what is causing it and if they have done a serious injury. X-rays, Ultrasound and MRI are some of the imaging techniques most used to diagnose musculoskeletal injuries. Unfortunately, scans cannot show your pain. In fact, when people with asymptomatic (no pain) joints are scanned, they have findings even though they experience no pain and have normal function.

In one study where they reviewed MRI findings of the lower back in both asymptomatic and symptomatic patients, they found that evidence of degenerative spine disease is common in asymptomatic individuals and increases with age (Chart 1). Many imaging-based degenerative features are likely part of normal ageing and not associated with pain and dysfunction (Brinjikji et al., 2015).

In another study, this time examining the shoulder with MRI,  the researchers found a high prevalence of tears of the rotator cuff in asymptomatic individuals. These tears were increasingly frequent with advancing age and were compatible with normal, painless, functional activity. “The results of this study emphasises the potential hazards of the use of scans alone as a basis for the determination of operative intervention in the absence of associated clinical findings” (Sher et al., 1995).

In a third study where they perform MRI of both shoulders in patients with unilateral shoulder pain (Barreto et al., 2019), it was found that Rotator cuff tears were present in over 88% of the asymptomatic shoulders, and up to 89% of acromio clavicular joint alterations (Chart 2).

Another reason to avoid imaging such as X-rays and CT scans, is that they use ionising radiation and it is best to limit how much you are exposed to it.

Lastly, people may be afraid of the findings shown on the scans, and they might stop using the joint and overprotect it, feeding the fear avoidance behaviour as they believe they might make the injury worse if they use it.

These are just some of the reasons why we prefer not to send you for imaging straight away, as we know that scans alone do not always explain the cause of your pain (remember that pain is multifactorial: beliefs, past pain experiences and stress can increase your pain). Instead, we prefer to show you which movements to avoid for a short time while your tissues settle, and which movements to do more often to make those joints more robust and resilient. 

So, then why is imaging important and when should you have it?

  • In cases when the pain is not going away in the expected time frame*, or when it is worsening. 
  • When there are worsening neurological symptoms (weakness, numbness, pins and needles).
  • When your practitioner thinks there might be a more serious undiagnosed pathology (ex. fracture) and wants to rule out red flags.
  • And when the patient needs to be reassured that there is nothing serious causing their symptoms. I think this point is important and should be discussed between the health practitioner and the patient.

* Expected time frames vary from person to person and depending on the injury. Many factors can impact your recovery. It is not only about tissue injury, but also about stress, sleep quality, your beliefs, your previous pain experiences (you can read more about this on my 3 part blog series What is pain? . For example, for rotator cuff related shoulder pain, up to 3 months of some pain and discomfort is acceptable.

Can an osteopath refer for imaging/scans?

Yes, in Australia Osteopaths can order x-rays, MRIs and ultrasounds, however you might have to pay a fee unless referred by your GP.

Do you have any questions or doubts regarding your scans? Please, do not hesitate to contact us via the CONTACT FORM or call the clinic and ask to talk to your osteopath.You can also make an online booking with your osteopath click here.

References

Brinjikji, W, Luetmer, PH, Comstock, B, Bresnahan, BW, Chen, LE, Deyo, RA, Halabi, S, Turner, JA, Avins, AL , James, K, Wald, JT, Kallmes, DF and Jarvik JG (2015), Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations, in American Journal of Neuroradiology, 36(4): 811-816.

Barreto, R. P. G., Braman, J. P., Ludewig, P. M., Ribeiro, L. P., & Camargo, P. R. (2019). Bilateral magnetic resonance imaging findings in individuals with unilateral shoulder pain. Journal of Shoulder and Elbow Surgery, 28(9), 1699–1706. https://doi.org/10.1016/j.jse.2019.04.001

Sher, JS, Uribe, JW, Posada A, Murphy, BJ, Zlatkin MB. (1995). Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am.;77(1):10-5. doi: 10.2106/00004623-199501000-00002. PMID: 7822341.

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