By: Jerry Moczerniuk
PT, DPT
Through the years MRI has been considered the gold standard for diagnosis of musculoskeletal disorders/conditions. MRI can accurately identify muscular, bony, tendinous, and other soft tissue abnormalities. These abnormalities can include ligamentous sprains, muscular strains/tears, bony changes, fractures, etc. MRI findings often drive the plan of care established for the patient, which may include conservative care, medications/injections, and even surgical recommendations.
MRI continues to be the gold standard in identifying abnormalities, but those abnormalities may NOT be the true cause of pain or symptoms with which the patient presents. Recent research in imaging and diagnosis recommends utilizing not only MRI findings, but also clinical correlation and patient history in establishing an appropriate plan of care.
There have been several studies identifying significant musculoskeletal abnormalities in individuals without any symptoms.
In 2014, 33 articles reporting imaging findings for 3110 asymptomatic individuals were reviewed. The prevalence of spinal disc degeneration in asymptomatic individuals was 37 percent in 20-year-old individuals and progressively increased to 96 percent of 80-year-old individuals.
A 2015 study looked at neck MRI findings of 1211 healthy, asymptomatic volunteers between 20 and 70 years of age. And 87 percent of those subjects presented with disc bulging on MR imaging. The extent of disc disease was however worsened with age.
These types of findings are not only isolated to spinal conditions. Research has also shown high prevalence of MRI abnormalities of the knee, hip, and shoulder in asymptomatic individuals.
A 2016 study of shoulder MR imaging of individuals between the ages of 45 and 60 showed a 72 percent prevalence of superior labral tears without symptoms. Likewise a 2012 study of hip MR imaging of asymptomatic individuals between 15 and 66 revealed abnormalities in 73 percent of hips, with labral tears being identified in 69 percent of the joints.
Most authors of those studies conclude that musculoskeletal abnormalities on MRI are not often traumatic in nature, but may likely be a part of a normal degenerative process. Furthermore, MRI abnormalities are frequently prevalent in asymptomatic individuals, and clinical correlation/clinical judgement should be utilized in determining whether an abnormality on MRI is the cause of ones pain/symptoms.
Your Physical Therapist should be considered a primary source for evaluation and treatment of musculoskeletal conditions. A skilled PT should be able to accurately identify the pain causing tissue, and set up a plan of care to effectively treat your condition without the need for drugs, injections, and costly surgical procedures.
The scope of a Physical Therapist practice allows PT’s in NJ to see patients without a referral, examine them thoroughly, diagnose musculoskeletal dysfunction and develop a plan of care (treatment) to improve function, decrease pain, regain mobility, and most importantly improve the patients quality of life. These services are typically covered by health insurance, even without a prescription.
Dr. Moczerniuk is a Doctor of Physical Therapy, member of American Physical Therapy Association, and a Clinical Director at db Orthopedic Physical Therapy of Manalapan, located at 120 Craig Rd. Suite 2. Dr. Moczerniuk can be reached at 732-462-2162 or via e-mail at Jerry@dborthopt.com. You can also find out more about our practice at dborthopt.com.
