“Should I get an MRI?”
Probably a question we get asked every day. There is a lot of certainty that comes with getting a scan and many of our patients experience a sense of relief when we have something definitive and can map our a clear plan based on clear findings..
Here are some reasons we send for an MRI:
Grading an injury - this helps us manage the time it will take to recover
Uncertainty - some people just want to know what’s wrong
It’s not responding as expected - maybe we need to clarify the diagnosis
Determining the diagnosis - if you can’t tell if it’s one thing or another and the management of the injury depends on the diagnosis
Often though, the answer is not always “yes, let’s get a scan” - and here are 3 strong reasons why…
The scan is likely to reveal a lot of information which may not be relevant
The pain may be driven by nerve sensitivity rather than a pathology
Getting a scan may not help us build a success plan together
When would a scan reveal irrelevant information?
Here’s what we know - normal degenerative changes on scans start to present themselves from the age of 30. So, if you’re 50, and have shoulder pain for example, it’s quite likely for us to see “degenerative tearing” of tendons, “cystic changes in the cartilage” and “osteophytic development”. I’m using the terms in case you’ve got an MRI and those phrases set off alarm bells. They are fairly common and reasonable findings for someone who has used their shoulder for half a decade.
When is something sensitive and when is something pathological?
We have a growing amount of evidence to suggest with certainty, that pain is not structural. Meaning, your pain doesn’t always come from what your scan says. 80% of disc bulges found on MRI are asymptomatic! If your pain follows a pattern that is in line with a pathology then a scan can help diagnose with accuracy - BUT if your pain changes from day to day or follows a pattern that isn’t in line with a particular pathology, then sometimes, the pain can come from something being sensitised. Curious? Watch this post on insta.
When wouldn’t a scan help us plan?
Generally, a scan won’t help us in 2 situations: You’re either already getting better, or we’re just sending for a scan to tell us what we already know. These situations do not indicate sending for a scan.