When do I need an MRI and how will this guide treatment?
Medical imaging such as X-rays, MRIs, Ultrasound, and others can be a great tool when worried about a medical emergency or planning for surgery. Unfortunately, outside of this, they often do more harm than good. The reason for this is medical imaging often shows findings that do not guide treatment decisions and cause unnecessary worrying.
One study of subjects with no history of pain or weakness showed shoulder abnormalities in 96% of subjects. The most common were bursal thickening (78%), acromioclavicular joint osteoarthritis (65%), supraspinatus (one of the four rotator cuff muscles) lesion (39%) and subscapularis (another rotator cuff muscle) lesion (22%).
Since these imaging findings are so common, they are like “wrinkles” or “grey hairs” on the inside. Rotator cuff, arthritis, bursitis may sound scary but they do not mean you need surgery.
A good clinician can rule out a “red flag” causing shoulder pain through a clinical exam and determine which patients need further imaging. Please see “When is someone with shoulder pain not a candidate for PT #5” (include link). If red flags are not present, more often than not it makes sense to start with the less invasive options first before pursuing more aggressive treatments such as surgery.
- Seitz, PT, PhD, DPT, OCS;, A., Christain, PT, DPT, OCS, SCS, H., Lutz, PT, DPT, PhD, A. and Shanley, PT, PhD, OCS, E., 2021. Current Concepts of Physical Therapy, 5th Edition-The Shoulder: Evidence-Informed Physical Therapy Patient Management. 5th ed. Academy of Orthopaedic Physical Therapy.
The shoulder (glenohumeral) joint is the third most common joint for arthritis, with the knee and hip being one and two, respectively.
Like many parts of the body, non- neuro-muscular-skeletal conditions can refer pain to the shoulder. These include heart, liver, stomach, pancreas, Pancoast’s tumor and spleen.
If your shoulder pain is in the region between the neck and the shoulder, between or around the shoulder blades or you have both neck and shoulder pain, odds are the neck is involved.