In today’s society we all want answers for what’s going on. We can google almost anything, including healthcare signs and symptoms. This often leads down the webMD black hole when it comes to healthcare. So, it’s not a surprise that the instant gratification of a shoulder MRI is what a patient expects when in pain. The problem is that there is a poor relationship between the findings in imaging and symptoms.
There have been multiple studies that took MRIs of shoulders on individuals who were asymptomatic and compared them to individuals who had pain or a history of pain. In one study they found that there was a high prevalence of tendon pathology and rotator cuff tears in all groups, regardless of pain.1
Another study looked at MRIs in elite volleyball players who did not have shoulder pain. They found that the majority of athletes had tendon pathology and partial rotator cuff tears. Additionally, a minority, 23%, had labral tears.2
What does that mean for me?
All this to say, your shoulder MRI does not dictate your symptoms or function. It likely won’t change the plan of care in physical therapy. An “abnormal” finding on an MRI does not always mean surgery. There are plenty of high-level athletes and everyday people with the same “abnormal” findings who are pain free.
When it comes to physical therapy, we perform an exam to assist the diagnosis for shoulder pain to differentiate between tendon, joint pathology or pain referred from another location. Furthermore, our plan of care is based on symptoms and presentation. When it comes to imaging, it’s typically only recommended when there is a serious pathology suspected, the patient does not respond to treatment as expected, or we believe that imaging could change the management of the patient.
After the evaluation, the goal is to temporarily remove painful triggers to allow things to calm down. At the same time, we are focusing on building strength in tolerable positions. Ways to alter training include load, tempo/speed, range of motion, and then the movement itself. Once things have calmed down a bit, we’ll gradually add back in previously painful movements to allow for return to sport and full activity.
If you’re dealing with shoulder pain and are looking for someone to get you out of pain, help you return to sport, and to stick with you to help prevent injury in the future–you’ve come to the right place! Reach out to find out how we can help!