A bad-looking scan may not explain your soreness

Many scan findings don't cause soreness

Shoulders and knees change over the years. A scan may show worn cartilage, the smooth cover on a bone's end. It'll sometimes show a small tear too. Many people have these changes without soreness.

The painful spot matters.

The scan matters more when it shows wear where you hurt. The same movement should bring on the ache. When it doesn't, your doctor will check other causes. A neck problem can even feel like shoulder soreness.

A rotator cuff tear or tendonitis needs an exam

Your rotator cuff raises and turns your arm. Tendonitis is the common name for a sore tendon that isn't working well. Repeated reaching may bring that soreness on slowly. A fall may cause sudden weakness instead.

The timing guides your doctor.

He'll test strength and motion. He'll ask about sleep and how the ache began. An MRI or ultrasound may help if weakness is severe. The scan can also show where a tear sits.

Your daily movement shows your progress

A scan may still look rough while you improve. That doesn't erase better strength or easier walking. A small scan change can also cause real trouble. Your daily movement fills in what's missing.

Check the tasks that matter to you.

Notice whether stairs feel easier this week. See whether your arm reaches a higher shelf. New weakness or fresh swelling needs another exam. Steady gains may matter more than another scan.

Sources

1. Fifty-one people aged 40-70 with NO shoulder symptoms in either shoulder had one shoulder scanned by ultrasound. Abnormalities were found in 96% of them: subacromial-subdeltoid bursal thickening in 78%, acromioclavicular osteoarthritis in 65%, supraspinatus tendinosis in 39%, subscapularis tendinosis in 25% and a partial-thickness bursal-side supraspinatus tear in 22%.

   Girish G, et al. — Ultrasound of the shoulder: asymptomatic findings in men.. AJR Am J Roentgenol, 2011. DOI: 10.2214/AJR.11.6971.

2. A meta-analysis of 63 studies covering 5,397 knees of asymptomatic, uninjured adults found cartilage defects in 24% overall and meniscal tears in 10%, rising sharply with age: cartilage defects in 11% of adults under 40 and 43% of those 40 and over; meniscal tears in 4% under 40 and 19% at 40 and over. Bone marrow lesions were present in 18% and osteophytes in 25%.

   Culvenor AG, et al. — Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis.. Br J Sports Med, 2019. DOI: 10.1136/bjsports-2018-099257.

3. This review of imaging in tendinopathy makes the central point that there is NO direct link between tendon structural disorganisation on ultrasound or MRI and clinical symptoms, so imaging findings can create a confusing clinical picture rather than clarify it. It also examines whether imaging predicts onset of pain or clinical outcome, and whether tendon structure has to improve for the patient to get better.

   Docking SI, et al. — Tendinopathy: Is Imaging Telling Us the Entire Story?. J Orthop Sports Phys Ther, 2015. DOI: 10.2519/jospt.2015.5880.

4. Across 516 hamstring injuries in 23 European professional football teams, 58% were imaged. Lay-off time tracked radiological grade closely: 8, 17, 22 and 73 days for grades 0 to 3. But 70% of the injuries were grade 0 or 1 - meaning NO fibre disruption visible on MRI - and those grades accounted for 56% of all days lost. Reinjuries were 16% of injuries and every single one was in the biceps femoris.

   Ekstrand J, et al. — Hamstring muscle injuries in professional football: the correlation of MRI findings with return to play.. Br J Sports Med, 2012. DOI: 10.1136/bjsports-2011-090155.