Magnetic Resonance Images (MRI) have become increasingly sensitive to detecting abnormalities and pathologies in our bodies. As the technology has advanced radiologists are far less likely to miss an abnormality in the musculoskeletal system, but are more likely to find abnormalities that may or may not be causing a patient’s current symptoms. In fact, abnormalities in pain free adults are very common in those over age 30 in the back (lumbar spine), neck (cervical spine), and shoulder. In some age groups the only abnormal scan is finding a normal scan. A recent research study was conducted in the knees of pain free adults and its’ results are consistent with our understanding of MRI imaging in the musculoskeletal system.
Horga and colleagues studied the MRIs of both knees in 115 uninjured, asymptomatic adults (Skeletal Radiology. 2020). Participants were 44 years old on average and 45% male. Radiologists reported abnormalities in 97% of knees, only 3% of the 230 pain free knees had no abnormalities. Specifically, meniscal tears were found in 30% of the pain free knees, cartilage and bone marrow lesions in over 50% of knees, and tendon changes were found in 20% of the knees. The high degree of abnormalities and pathologies in asymptomatic patients questions the value of these images in isolation without consideration of a patient’s history and their clinical examination. Many individuals in the health care system will have pre existing abnormalities which may or may not be contributing to their current symptoms. Importantly, many of these patients will return to pain free status after successful Physical Therapy treatments, but their images will likely remain the same.