Shoulder pain and MRI findings. How do they correlate?

Nowadays we are getting more and more evidence that there is a poor correlation between imaging and pain, therefore is a strong message to use a biopsychosocial model when assessing a pain condition.

This is true above all talking about chronic pain.

This means that a detected “abnormality” in the Instrumental imaging(MRI, CT-scan, ultrasound scan etc.) not always correlate or can explain the pain.

In a study of 2019, Barreto R.P.G. and colleagues analysed the correlation between MRI in the shoulder and the relationship with pain.

In the study were evaluated 123 subjects with Unilateral chronic shoulder pain, for each participant were examined the symptomatic and asymptomatic shoulder.

What did they find?

• Symptomatic and asymptomatic shoulders’ MRI findings don’t show significant differences
• Structural abnormalities in shoulders are quite common in the population
• This study confirms the findings of previous studies which have shown:

• The presence of bilateral alterations in the MRI findings in individuals with unilateral symptoms 
• The presence of alterations in the MRI findings in asymptomatic individuals.

 A previous study which examined 51 subject who had no symptoms in either shoulder found that: Asymptomatic shoulder abnormalities were detected in 96% of the subjects examined.

What is the importance of these new discoveries?

This is important for:

• Healthcare professionals: such as physicians, surgeons, and physical therapists who might use the MRI findings to guide the decision toward a treatment plan. Surgeons should take in account not only MRI findings but as well clinical findings and patients’ will before deciding on a surgical procedure.

Physical therapists should use a biopsychosocial model to guide diagnosis and treatment planning instead of relying on a pathoanatomic

Model which would probably lead to a poor outcome.

People suffering from a chronic shoulder pain: the understanding that the alterations found are common and may not be the source of pain can help to avoid any NOCEBO, due to the false belief that the pain is related with something of wrong with the shoulder’s joint.

References:

Barreto R.P.G.  et al(2019), Bilateral magnetic resonance imaging findings in individuals with unilateral shoulder pain.

doi:10.1016/j.jse.2019.04.001

Girish G. et al(Oct 2011), Ultrasound of the Shoulder: Asymptomatic Findings in Men

doi: 10.2214/AJR.11.6971.