MRI Scan - Do I Need One

With advancing technology in healthcare, MRI scans are generally considered as the gold standard for diagnosing musculoskeletal conditions. The scans can show what is happening in a wide variety of body tissues and so can be useful in diagnosing what tissue or structure has been injured and to what extent. This can then help with the management of the injury and also give an idea of whether non-surgical or surgical treatment is most appropriate.

So, surely having an MRI scan is appropriate for all musculoskeletal injuries and it’s only because of finance that they aren’t always offered? Well, no. Unfortunately, even if money is no object, having an MRI scan does not always lead to best management. For a start pain is very complex and although an MRI scan can show tissue damage, it doesn’t always correlate with the patient’s pain or indicate that the pain is actually coming from that damaged tissue. It is also difficult to tell when that tissue was damaged and therefore whether the damage was there before the current pain started. Furthermore, a number of studies have been conducted using MRI scans on asymptomatic (pain free) patients and showed tissue damage in large numbers of them. For instance in a study of over 3000 people aged between 20 and 80, disc degeneration was seen in 80% of them (1). Similar studies have shown over 70% of people between the age of 40 & 90 have osteoarthritis (2) and 75% have some type of shoulder pathology (3).

What does this all mean? Well, it shows that we all probably have some areas of tissue damage in our bodies without us even being aware of them. These may the result of an old injury or just general wear and tear. It also shows that the human body is incredibly adaptable and able to cope with what we might consider an abnormal/damaged structure.

So, do you need a scan for your injury?  Well, every case has to be taken individually and whilst a scan may be helpful it can throw up red herrings leading to unnecessary worry on the patient’s part.  Physiotherapists are equipped to carry out thorough assessments of injured areas as well as surrounding structures to help plan the best management.  Most of the time symptoms can be improved with conservative (non-surgical) management, enabling patients to get back to their daily function without the need for a scan. They are also experienced in recognising when further intervention or even surgery may be required and having a scan is appropriate. In this case they will always recommend that you have one and be happy to make a referral back to your GP or consultant.

Before pushing for a scan which ultimately could lead to unnecessary surgery it is worth having conservative treatment and giving your body the chance to heal by itself.  Physiotherapy can help your body to recover through individualised treatment and rehabilitation without the scars to show.  Remember once surgery is done it cannot be undone regardless of the outcome.

(1) Brinjiki et al (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American journal of neuroradiology.

(2) Guermazi et al (2012). Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study). British medical journal.

(3) Girish et al (2011). Ultrasound of the shoulder: Asymptomatic findings in men. American journal of roentgenology.