“They certainly give very strange names to diseases.” – Plato
When a doctor orders an x-ray, ultrasound, MRI (or any other test for that matter), it is done to help make a diagnosis of the patient’s problem after a thorough history and physical exam are performed. This in turn guides the treatment, and patients don’t need to have a medical certificate to recognize that “the treatment is only as good as the diagnosis”. When test results come back, patients want to learn what the findings mean and how this information can support their recovery – getting clarity is the first thing on their list. Unfortunately, patients are often introduced to a barrage of medical terminology which does not create more lucidity – in fact, they leave the doctor’s office feeling even worse with a bowl of murky information soup swimming inside their heads, not quite knowing what to do next. And finally, in addition to the daunting task of having to interpret medical terminology, patients are sometimes informed that there are other “unrelated” issues found on the x-ray or MRI… in areas where they aren’t even experiencing any pain!
So, what do doctors do with this information and how are patients supposed to process it?
Radiologists are trained doctors who interpret all of the imaging studies (X-rays, MRI’s, CAT scans etc.). In the radiology report handed over to an MD/DO, sometimes the words clinical correlation required will be included. Basically, this means that there may be some identifiable problems or what doctors call “pathology”, but they may not be clinically active or significant. Here is one of many examples, as cited in a general population study (J Bone Joint Surg Am 1995;77:10–5.): MRI studies were performed on “asymptomatic” patients – those who are not experiencing pain – and the results showed that 35 out of 100 patients had at least partial tears of the rotator cuff. Similar findings were also seen in the lumbar spine – the lower back region – when general population MRI studies were again performed on asymptomatic patients.
The important part of the diagnostic process in musculoskeletal medicine is to not only correlate the physical exam findings with the x-ray or MRI, but to also look for any possible “bio-mechanical precursors” to the problem such as abnormal motion patterns of the shoulder blade (scapula) thus predisposing the patient to shoulder pain, or tight hip flexors leading to inhibition or inactivation of muscles that stabilize the lower back region. In the orthopeadic paradigm, we diagnose a patient’s problem by reproducing their typical symptoms during the physical exam and then order the appropriate study – such as an MRI – if the patient doesn’t get better with conservative measures such as manual or physical therapy… or if the patient is potentially a candidate for surgery. By linking the physical exam, patients’ complaints and the radiological findings, doctors can offer a more accurate, meaningful, applicable, and successful treatment to patients.
When this happens, clarity becomes the first thing patients experience… not the last.