A lot of people come to see me having been told that they need a scan – usually an MRI scan – by their therapist or GP and some come with the scan already done. They then look a bit surprised when I don’t organise an MRI straight away or look at their scan immediately.
That is because the most important aspect in making a diagnosis is listening to your story – what medics call the ‘history’. So that is what comes first. After that comes the examination and only then do I think about imaging.
It is also important to match the right sort of imaging to the individual patient’s story so that we get the most relevant information back. Frequently simple x-rays are enough but you may need an MRI scan, an MRI Arthrogram, a CT scan or, more and more often, an Ultra-sound scan.
There are potential problems with any sort of imaging and the biggest one is that can and do show abnormalities which are not actually causing you any problems. And that is why I have to match what I see on the scans with what I found out when you told me about your painful shoulder and I did the examination. If you did an MRI or USS on 100 people who had NO shoulder problems at all, there would be some sort of abnormality in about 90%!
So, imaging is important but does have to be tailored to your condition and only comes after listening to your history and doing an examination.
