#4 Imaging is Not a Guarantee

     Hello again. I am a bit behind on my weekly updates, but I am going to try my best to catch back up. I performed a patient evaluation today that reminded me of another evaluation I completed a couple weeks. I had been waiting to post about the older case because I wanted to provide some evidence-based research to back it up, but I will end up just posting that on my main blog page soon. Both of these cases involved the patient providing imaging results during their evaluation.

Case #1 –Bulging Disc vs. Hip Tendon Pathology
     The patient came in with complaints of hip pain, which came on gradually to his/her recollection. During the history taking, he/she immediately inquired about whether or not we had his/her imaging results. I politely acknowledged that we did receive them, but we would discuss the results later on. The patient was convinced, due to the imaging results, that his/her pain was being caused by the bulging disc in his/her lumbar spine. The patient did not present with a symptomatic bulging disc, and I say this because not all bulging discs cause pain or symptoms (this is the research evidence I was referring to). The patient  presented with evidence indicating the presence of a hip flexor tendon pathology, where a contraction and palpation of those muscles elicited pain.

Case #2 – Osteoarthritis vs. Shoulder Tendon Pathology
     The patient came in with complaints of shoulder pain, which started after a day of heavy lifting where he/she moved into a new home. During the history taking, he/she referred to the imaging performed on the painful shoulder that revealed osteoarthritis. Once again, this patient was confident that the pain was being caused by what the imaging results stated. However, imaging results were again not the cause of his/her pain. The patient presented with evidence that indicated the presence of a rotator cuff tendon pathology, specifically the supraspinatus and teres minor, as well as a long head of the biceps tendon pathology.

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     The general public has become reliant on imaging and believes that the results will have all the answers. The fact of the matter is that this is just not true. Yes, imaging gives us more information into what can be causing dysfunction, but the results should not be all we look at to confirm a diagnosis. As movement experts, we primarily rely on what the body tells us and what our patients tell us during their movements in order to diagnosis a musculoskeletal condition.


- Patrick Berner, SPT