# The Limitations of MRI and Ultrasound in Diagnosing Pain
>[!example] 05 May 2023 #blog
%%[[asymptomatic shoulder abnormalities were found in 96% of subjects]]%%
Over the years, many of my clients have asked about MRIs and Ultrasounds. They want to know if having a scan could help to explain why they have pain. Whether it's knee, shoulder, back or anywhere else that they are it.
My answer? Maybe. Maybe not.
Because the fact is, having an MRI or Ultrasound is only one part of the jigsaw. One to be interpreted alongside clinical findings to determine the cause of symptoms.
After all, we know that pain does not always correlate with damage (or abnormalities).
According to the research by Girish et al. in 2011, shoulder abnormalities were found in 96% of the subjects.[^1]
![[Shoulder abnormalities found in 96% of subjects without history of pain or weakness.excalidraw.png]]
But the thing is that these subjects were selected because they had NO pain at all. They were what we refer to as 'asymptomatic'.
And in looking further at the findings in more detail:
- 78% of these had thickening of the bursa
- 65% had joint osteoarthritis
- 39% had supraspinatus tendinosis
- 25% had subscapularis tendinosis
- 22% had supraspinatus tears
- 14% had labral abnormalities
So these people had something that many medical professionals believe is an issue. An issue that requires surgery. And yet they are experiencing *no* pain or dysfunction.
Again these have scans that look like they require surgery. But no pain or dysfunction. So should we operate?
So what if we flip it?
What if we take a scan of someone who *is* in pain, who has the findings of those people above. Can we determine that the abnormality is the reason for their pain?
Because surely, if that was the case, then EVERYONE who had those findings should have pain, right? Wrong. Again, see the results above!
Everyone is different. For some, their findings *may* be the cause of their pain. For others, it may not be quite as simple.
[^1]: %%[[(Girish et al., 2011)]]%% Girish, G. et al. (2011) ’Ultrasound of the shoulder: asymptomatic findings in men.’. AJR Am J Roentgenol, 197, 4, W713-9. Available at: [https://pubmed.ncbi.nlm.nih.gov/21940544](https://pubmed.ncbi.nlm.nih.gov/21940544)