Fascinating, but not surprising study, weighing in on the belief by many physicians (and patients) that x-ray or MRI findings are good at explaining why a patient has pain-in this case focused on shoulder x-ray findings.
It might surprise most people to learn that the width of the cartilage remaining in their shoulder joint or the amount of bone spurs doesn’t correlate to pain or function, meaning patients with little joint width left or many bone spurs were no more likely to have pain or lost function than those without those findings. This fits with many other studies in the knee and low back that show the same thing: findings on imaging studies such as MRI and x-ray often don’t tell us why the patient hurts. In the knee for example, 60% of middle aged or elderly patients with meniscus tears had pain and 60% of patients with meniscus tears had no pain. This whole concept needs to start changing our approach to orthopedic care as I have discussed in our practice’s book on regenerative medicine and stem cells-Orthopedics 2.0. We as physicians need to stop believing that a picture is a substitute for a good history and comprehensive physical exam. As doctors, our thumbs are often better (a hands on exam) at determining where the pain might be coming from than an MRI.
What was interesting about the study was that one bone spur did correlate with lost function. This is the bone spur at the bottom of the shoulder joint often seen in patients with advanced shoulder arthritis. This makes sense, as this bone spur would retrict lifting the arm up and above the head, as it would get in the way of the ball moving downward in the socket as the arm moves upward. We’re beginning to work on non-surgical solutions for removing this bone spur using barbotage, to see if getting rid of this spur through a needle may help these patients have better shoulder ranage of motion without the need for surgery.