Shoulder Pain Exposed: Debunking MRI Scan Myths!
By Shane Dowd, CES, CMP
The MRI Puzzle: Is Your Shoulder Pain Really What It Seems?
Imagine this: you have two shoulders—one hurts, the other doesn't.
Yet, when you look at the MRI scans, both shoulders look exactly the same.
It's puzzling, right?
This scenario raises a big question: is your shoulder pain really what it seems on an MRI?
Why Your Shoulder MRI Might Be Telling You Lies
Many of us, whether athletes, gym enthusiasts, or anyone leading an active lifestyle,
have been conditioned to believe that an MRI is the gold standard in pinpointing what's wrong inside our bodies.
But here's the kicker—MRIs are not as infallible as we’ve been led to believe.
In fact…a recent study revealed a startling truth…
The study scanned 123 people aged 18-77 who had one painful shoulder and one pain-free shoulder. Both shoulders scanned, and the results were shocking. They found…
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Rotator cuff tendinopathy in both the painful and pain-free shoulder
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AC Joint Degeneration in the painful and pain-free shoulder
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Subacromial bursitis in the painful and pain-free shoulder
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Labral lesions in the painful and pain-free shoulder
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Partial AND full-thickness rotator cuff tears in both shoulders
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And gleno-humeral joint arthritis in (you guessed it) BOTH shoulders
These findings clearly show that what we often assume is the source of pain (a bad X-ray or MRI) could very well be present in any normal, pain-free shoulder.
So why does this matter?
Well, imagine the real-world impact on YOU if you get your painful shoulder scanned and “bad stuff” shows up, BUT this “bad stuff” isn’t actually the root cause of your pain!
Believing that every anomaly on an MRI scan corresponds directly to your pain can lead to over-treatment—sometimes invasive—or chasing after the wrong solutions, which piles on medical bills and mental burden.
In other words…1 bad shoulder scan could mean wasting thousands of dollars chasing unnecessary treatments like drugs, injections, and surgeries!
The bottom line is this: This study and others show that while they provide a piece of the puzzle, they do not provide the entire picture.
MRI Interpretation: All “In The Eyes of the Beholder”?
This brings us to another crucial point: interpreting MRIs is as much an art as it is a science. Radiologists can see an image, but connecting that image to a patient’s pain involves considerable judgment and experience.
Some studies, like this one, even show that different experts looking at the same scans come up with a wide variety of diagnoses!
Understanding these shortcomings is vital for anyone undergoing an MRI for shoulder pain. It's not just about what the scan shows; it's also about who interprets these results and what the context of your unique symptoms and history is.
This understanding underscores why a comprehensive diagnostic approach is essential. A good one should include a physical examination and consideration of functional limitations and goals, not just reliance on imaging results.
This holistic view ensures a more accurate diagnosis and appropriate treatment plan tailored to your specific needs. Rather than a simplistic “bad picture, must fix with knife” approach.
Putting Knowledge into Practice: The Tale of Two Shoulders
To truly grasp how MRI insights translate into the real world, let's consider a practical case study: the tale of two shoulders.
About 11 years ago, I was dealing with a shoulder impingement in my right shoulder that just wouldn’t go away…
I got some scans on my spine and shoulders and the results weren’t pretty.
Doctor Dan: “This looks like a clear case of subacromial impingement, son. The good news is, we can just shave this bone down, and you’ll be right as rain!”
Shane: “Umm…but I notice that when I do some stretching and postural exercises to reposition my should and scapula, I seem to get more clearance in that shoulder…shouldn’t I just stick with that…”
Doctor Dan: “Haha, oh my young, naive boy… this is structural. Only changing the structure will fix this!”
Shane: “How much will that be?”
Doctor Dan: “Oh, a mere $21,000 and a few months of recovery is all…”
Shane: “Umm…I’ll think about it…*backing away*
The crazy thing is, my LEFT shoulder had the same morphology, AKA the same bone shape.
That’s why, if we just took MRIs to be the ultimate "Donuts of Truth," we would probably immediately inject or operate all painful shoulders…much to the happiness of “Dr. Dan” who is all too happy to put all his face in his technology.
Understanding the science of MRIs can help us avoid risky injections or surgeries. Instead, we can prioritize exercises and lifestyle changes to us, as athletes feel better.
I’m thankful to say that, many years later, and still surgery free, my shoulders are perfectly strong, capable and pain-free.
This scenario highlights why it’s crucial to go beyond the scan.
A comprehensive diagnostic approach involves not only examining MRI results but also conducting a thorough physical examination, assessing movement patterns, and understanding the patient's daily activities, sports involvement, what they are currently trying to do to fix the problem, and more.
This approach helps us identify the actual triggers of pain rather than just treating them based on imaging.
Straight From The Radiologist's Mouth
This also isn’t my crazy theory… even the European Society of Radiology published a paper in 2022 that summarized what noted radiologists and experts could all on. They said:
“The inherent uncertainty of radiological findings means that while they are indispensable to the diagnostic process, they do not singularly dictate treatment. Understanding and interpreting these findings within the broader context of patient symptoms and clinical history is crucial”.
Here’s the take-home message for anyone about to undergo an MRI: these insights are valuable because they can help reveal structural details. But they don’t always tell the full story of one’s pain or discomfort.
Therefore, combining MRI findings with a detailed evaluation ensures that treatment addresses not just the symptoms shown in the scan but also the functional and biomechanical issues that might be contributing to your discomfort.
This balanced approach leads to more targeted and effective treatment strategies.
For example, when one of the Doctors of Physical Therapy on my team is working 1:1 with a shoulder pain student, the FIRST thing we do is a comprehensive shoulder assessment. Do we consider the scans? Yes, but not in isolation, as if they were the only things that mattered.
The Best Approach For Most: Smart Strength & Mindful Mobility
So, if we aren't going to bow down to the almighty MRI alone, what can we do to heal shoulder pain now?
For the vast majority of people who don't have any "red flags" on their MRI and physical exams, they should simply focus on strength and mobility instead of surgery.
A holistic approach (like the TSR Method that we teach) will help to diagnosis and treat your individuals symptoms, while taking into consideration the constellation of other factors that contribute to shoulder pain.
Top Takeaways: Fixing Your Pain For Good
To wrap up, let’s summarize the key takeaways from our discussion about shoulder MRIs.
First and foremost, remember that MRIs are an imperfect predictor of shoulder pain.
Second, it’s crucial to use a combination of diagnostic tools to achieve an accurate diagnosis. This means integrating MRI results with a thorough physical examination and an assessment of your symptoms and daily activities.
By doing so, we ensure that the treatment plan addresses not just the abnormalities seen on the scan but also your specific functional needs and goals.
Two Ways To Fix Shoulder Pain Now
If you are dealing with shoulder pain, there are two ways we can help you now:
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We have a top-rated “DIY” shoulder pain program called “Super Shoulders
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We have 1:1 personalized coaching with a team of Doctors of Physical therapy
If you are ready to start tackling the problem yourself, check out the Super Shoulders program.
If you want to apply for our 1:1 Mentorship, go to gotrom.com/vip for more info.
I hope this video was helpful! If so, please like, share and subscribe. And, as always, please remember, you’re just 1 step away from building (or rebuilding) your perfect body.
About The Author
Shane Dowd, CES, CMP, is the owner/founder of GotROM.com. He is also a sports performance & mobility coach specializing in injury prevention and flexibility for athletes.
