Imaging technologies, including MRI, continue to improve providing valuable insight into the human body. These advancements have made MRI scans extremely sensitive to identifying tissue pathology and the presence of disease within the body. In the musculoskeletal system, the MRI’s sensitivity reduces its’ ability to specifically detect symptomatic vs. asymptomatic pathology. For example, after age 30 many pain free Americans will demonstrates disc injuries and nerve compression on a MRI scan. These tissue changes may or may not play a role in a patient’s clinical presentation emphasizing the need to correlate every image with a patient’s history and clinical examination. In addition to the lumbar spine, tissue changes associated with pain including rotator cuff tears in the shoulder and meniscal tears in knee have also been found in significant numbers among pain free individuals. A recent review of the literature reports on the prevalence of osteoarthritis findings among pain free individuals.
The British Journal Of Sports Medicine reported on the known research on positive MRI findings of knee osteoarthritis among asymptomatic individuals (Culvenor et al. 2019). Authors included 63 studies of 5397 knees and found an overall prevalence of arthritis (cartilage defects, bone marrow lesions, osteophytes, and meniscal tears) of 24%. As expected these results increased with age as 43% of those over 40 years old demonstrated arthritis on MRI. Conversely, only 14% of knees under 40 years old displayed diagnostic features of arthritis.
Consistent with prior research, this study supports the clinical truths of “many painful knees do not display arthritis and many knees with arthritis are non painful”. Further, it has been said the difference between pathology and pain is the patient. Thus many individual factors including activity level, strength, mobility, and overall health play a role in the degree of symptom presentation from an arthritic knee.
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