The Limitations of Diagnostic Findings

A number of scientific studies have come to my attention recently that I wanted to share. All of them apply to MRI (magnetic resonance imaging) and present some interesting points. When pain or problems occur in our body, the gold standard of testing is often the MRI. Your physician can only tell so much from external physical examination and the MRI is typically used for more in-depth testing. While the results can be illuminating, they often do not tell the whole story. Let me explain by telling you about a few of these studies.

Prevalence of annular tears and disc herniations on MR images of the cervical spine in symptom free volunteers.
“CONCLUSION: Annular tears and focal disk protrusions are frequently found on MR imaging of the cervical spine, with or without contrast enhancement, in asymptomatic population.”

Magnetic resonance imaging of the lumbar spine in asymptomatic adults.
“We performed magnetic resonance imaging of the lumbar spine on 66 asymptomatic subjects and found that 12 (18%) had either a disc protrusion or herniation. An additional 26 (39%) had a bulge that was associated with degenerative disc disease. We also found examples of spinal stenosis, narrowed nerve root canals, osteophytes, and vertebral body involvement with multiple myeloma. Degenerative disc disease is a common finding in asymptomatic adults that increases in frequency with age. It occurs more frequently in men and usually involves more than one level. The most common location is L5-S1.”

Dead men and radiologists don’t lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence.
“CONCLUSIONS: Rotator cuff tears are frequently asymptomatic. Tears demonstrated during radiological investigation of the shoulder may be asymptomatic. It is important to correlate radiological and clinical findings in the shoulder.”

Spinal Stenosis, Back Pain, or No Symptoms at All? A Masked Study Comparing Radiologic and Electrodiagnostic Diagnoses to the Clinical Impression
“Conclusions: The impression obtained from an MRI scan does not determine whether lumbar stenosis is a cause of pain.”

So what can we learn from these studies. Essentially, they are showing that positive MRI results do not point to the findings as the cause of the pain. They in no way prove that the MRI results do NOT show a pathology or problem, just that the identified problem may not be the true cause of the pain. When surgery is the frequent next step from a positive MRI, these studies should be seriously considered.

Take the first study as an example. The researchers took 30 symptom-free volunteers and found that the “prevalence of bulging disk and focal disk protrusions was 73% (22 volunteers) and 50% (15 volunteers), respectively. There was one extrusion (3%). Eleven volunteers had annular tears at one or more levels (37%) and 94% of the annular tears enhanced after contrast injection. Asymptomatic medullary compression was found in four patients (13%).” So these abnormal findings were present in these subjects who had no history of neck pain. If a person who was experiencing neck pain with possible disc symptoms went in for an MRI, how can one truly judge, based only on the MRI results, if the pain is coming from the disc problem, or if it from other sources. Might this account for the less than stellar results that many of our friends and acquaintances have reported after disc surgery?

The other three studies give similar findings, in that the MRI alone does not provide a clear-cut answer to the cause of pain. With information such as this, one can see why pursuing options besides surgery is a good first choice. There certainly are instances where surgery is the best and only choice, but without trying options such as Myofascial Release at the Pain Relief Center, you are left to wonder. Through an innovative evaluation and treatment method, Myofascial Release at the Pain Relief Center excels at determining whether soft tissue tightness is a contributing factor to pain.