Do You Have an Incidentaloma?
A What? That's right - an Incidentaloma?
An incidentaloma is something that is seen on a X-ray, MRI or CT scan that is incidental.
That means something can be seen that is not "normal;." BUT it has nothing to do with the reason you had the test. This thing that is "not normal" often results in more tests or in treatment that won't do anything.
If you are lucky - you wont end up with more tests or getting treatment you don't need. In the US, many with joint pain DO end up with a lot of medications, injections, and surgery they don't need based on incidental findings on X-rays, MRIs, and CT scans.
MRI versus CT Scans
An MRI uses strong magnetic fields and radio waves to create a picture of the inside of your body. No dangerous radiation like that found in X-rays is used. The strong magnets can cause problems with implants in your body though.
You usually lie still in a confined space for a long period of time. The magnets impact the molecules in your body and cause them to give off signals. A computer reconstructs an image of the inside of your body from these signals.
CT scans use X-ray radiation to make a detailed picture of the inside of your body. X-ray radiation is dangerous and can cause cancer. X-rays create a pictures based on the ability of the tissue to block the radiation from getting through.
CT scans are faster than MRI scans. A computer puts together the x-rays to give a detailed picture of the inside of your body.
For some things, an MRI picture is better. For other things, a CT scan is better.
Even if one is better, the other can sometimes be substituted. For example, if you body contains some kid of metal you might not be able to have a MRI. If that happens, a CT scan might be done instead.
The US Incidentaloma Epidemic
According to the January 22, 2019 Journal of the American Medical Association these "incidentalomas" are the result of EXCESSIVE MRI and CT scans done in the US.
People in the US get 5 times as many CT scans as people in Finland
People in the US get 3 times as many MRI scans as people in Finland
Every Year in the US
CT Scans - 245 of every 1000 people get one
MRI - 118 of every 1000 people get one
Together - 363 our of every 1000 people in the US get an MRI or CT scan every year
CT Scans can Cause Cancer
Another problem with the extra CT scans is radiation.
In 2015 Consumer Reports stated that 2% of all future cancer cases in the US will occur because of CT scans. This includes:
29,000 new cases
15,000 deaths a year
Dr. Tim Flynn, in his 2016 lecture, estimated that 4,000 people a year die from cancer due to unnecessary CT scans of their back.
X-rays, MRI, and CT Scans and Surgery You Many Not Need
These "pictures" are responsible for a lot of treatment that isn't needed. This happens when normal degenerative changes show up. Common areas include the shoulder rotator cuff, knee meniscus, or discs of the neck and back.
It's pretty common for someone with shoulder pain to end up looking at an MRI with their surgeon. The surgeon points out the tears and bone spurs on the MRI and talks about a repair, clearing up the fraying, or doing a "clean-up." You can see it for yourself. And it seems logical to you, so you go ahead and have the surgery.
Research Says Your Surgery if Often Not Needed
Times have changed. Not long ago I would have agreed and recommended surgery too. Things have changed and we now know things on the X-ray, MRI or CT scan are normal and are often not causing the problem with pain.
The problem is what you were looking at on the MRI was probably there before your shoulder started hurting. The average person has these changes by middle age. So the shoulder pain isn't caused by these changes. There are lots of studies that also show this for knee pain, neck pain, and back pain.
Some of the most powerful research studies are for spinal stenosis. Studies have been done comparing treatment with "only therapy" to treatment with "surgery plus therapy." Research studies show that the "only therapy" treatment works just as well as the "surgery plus therapy."
Then What Causes the Pain?
It's easier to explain with an example. Let's stick with the shoulder. Your shoulder hurts because it isn't working correctly. It's usually not working correctly - or moving correctly - because of a problem with your neck, rib position, posture, movement of your collar bone, coordination of shoulder blade muscles, ... When your shoulder doesn't move correctly the tissue gets pinched, and you end up with pain and inflammation.
When you address the reason your shoulder isn't working correctly, the pain and inflammation go away. If you don't correct the problem, the pain will come back. That's why just taking pain medication or getting an injection don't work. That's why pain comes back after surgery. Surgery doesn't fix the problem. The problem was your shoulder wasn't moving correctly. Cleaning it out or removing bone spurs won't fix that.
Save Yourself, Your Family, and Your Friends from the X-ray, MRI, and CT Scan Trap
A lot of research comparing physical therapy alone to physical therapy plus surgery is new. These studies were done in the last 5-10 years. So make sure no one you know falls for the X-ray, MRI, or CT scan traps.
Make sure the cause of your pain is treated. It takes good physical therapy to figure out and then treat the cause of the pain.
Good Physical Therapy
Make sure your friends and family get good physical therapy at an office where they will take care of ALL the reasons that cause poor shoulder motion and eventually pain - the neck, ribs, posture, collar bone motion, muscle coordination, etc. It's similar for pain in your neck, back, shoulder, and all the other joints in your body.
Christopher DiPasquale, PhD, PT, OCS, SCS, CHT is a physical therapist at Performance Physical Therapy & Sports Medicine, with offices in Hebron and Colchester, Connecticut. He is board certified by the American Board of Physical Therapy Specialties in Orthopedic Physical Therapy and Sports Physical Therapy and a Certified Hand Therapist by the Hand Therapy Certification Committee. Visit pptsm.com for more information. You can call the Hebron office at 860-228-4883 or send an email to firstname.lastname@example.org. You can call the Colchester office at 860-537-3014 or send an email to email@example.com.