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Fitness

You Are Not Your Shoulder Ultrasound

A physical assessment is imperative in determining whether your abnormal anatomy is functionally normal for you.

Written by Cassie Dionne Last updated on March 21, 2016

When we use imaging to look at the spine, we can see things like degeneration, disc bulge, scoliosis, or maybe even an extra vertebra. These findings can make clients feel like they are broken or something is wrong with them. They will probably also assume the findings on this MRI are the reason or root cause for their pain.

I explained previously that just because an X-ray, CT scan, or MRI shows an “abnormality” does not necessarily mean someone needs fixing. Often, that abnormality is simply that person’s normal.

An awareness is starting to trickle down to clients and the general public that an abnormal diagnostic image is not necessarily relevant to treatment. But for some reason, this logic seems to be isolated to the spine. An abnormal result in any other body part still seems to lead everyone to believe that it is also the reason for pain, injury, or dysfunction.

If people can have abnormal results in the spine but are otherwise completely asymptomatic, why can’t the same be true for other parts of the body, like the hip or the shoulder?

Diagnostic imaging can show abnormalities (like this rotator cuff tear), but those don’t always translate to dysfunction.

Who Has “Normal” Shoulders?

This question was the subject of a study published in the American Journal of Roentgenology. Researchers analyzed findings of shoulder ultrasounds to determine the prevalence of any “abnormality” in otherwise healthy, asymptomatic men. The study looked at 51 men ages 40–70 who had no symptoms in either shoulder.

An ultrasound of one shoulder per patient was performed by a sonographer according to a defined protocol, which included imaging of five areas:

  1. Rotator cuff
  2. Tendon of the long head of the biceps brachii muscle
  3. Subacromial-subdeltoid bursa
  4. Acromioclavicular joint
  5. Posterior labrum

The scans were then analyzed by three radiologists in consensus, with subtle or questionable findings (mid tendinosis, bursal prominence, and mild osteoarthritis) being omitted.

When Problems Aren’t a Problem

Researchers discovered subacromial-subdeltoid bursal thickening in 78 percent of the subjects. Bursa are thin, fluid-filled sacs that reduce friction in joints and help facilitate gliding of muscles and tendons over and through them. Typically, thickening of the bursa indicates inflammation and has been thought to cause pain.

But the men in the study were completely asymptomatic. 

Further analysis showed the following:

  • Acromioclavicular joint osteoarthritis in 65 percent of the men.
  • Supraspinatus tendinosis (damage/degeneration of a tendon of one of the rotator cuff muscles) in 39 percent of the men.
  • Subscapularis tendinosis (another rotator cuff muscle) in 25 percent of the men.
  • Partial-thickness tear of the supraspinatus tendon (a third rotator cuff muscle) in 22 percent of the men.
  • Posterior glenoid labral abnormality (an abnormality in the fibrocartilage ring that runs around where the upper arm bone fits) in 14 percent of the men.

Shoulder injury chart

All of these men had abnormal anatomy revealed in their ultrasound, but were asymptomatic. So are they really abnormal?

In Plain English, Please

To translate all the anatomy-nerd-speak, the study found that abnormalities were found in 96 percent of men who have absolutely no pain or issues with their shoulders. They are simply living their lives as usual, but an ultrasound shows an “abnormality.”

Just like we learned with MRI for the spine, results of ultrasounds for shoulders should be interpreted closely and combined only with clinical findings to determine the cause of symptoms. Seeing a skilled physical therapist who can assess the reason for shoulder pain is still required, regardless of what an ultrasound finds. Maybe you are one of the individuals who has a tear in your shoulder, but it is causing you no pain. If this is the case, imagine how upset you would be if you repaired the tear, only to find out that your pain came back because the root cause of your injury was never discovered or rehabilitated?

If It Ain’t Broke…

Always read results of imaging with an understanding that they do not mean you are broken. Imaging is a fantastic tool, and at times is incredibly important for injuries. As a physical therapist, there have been times when I have had to push for images to confirm clinical diagnosis. But the imaging results cannot be viewed in isolation from the bigger picture.

Just because the results of an X-ray, MRI, or ultrasound show something abnormal, please don’t take that as a reason to stop working on your strength, mobility, or range of motion. You are not “broken” or “abnormal.” Stay the course, keep working hard to rehabilitate your injury, and recognize the results for what they are: a single piece of the overall you.

More Training and Rehabilitation Science:

  • You Are Not Normal – Here’s Why
  • Myths About Disc Bulges: They Are Not Forever – But Training Is
  • Get the Diagnosis Right: It’s Not Tendonitis, It’s Tendinosis
  • New on Breaking Muscle Today

Image courtesy of Wikimedia Commons.

About Cassie Dionne

Cassie is the lead physiotherapist at Taylored Training Fitness Studio in Kingston, Ontario, Canada, where her goal is to change the way physiotherapy is done. Tired of hearing athletes complain about going to a therapist who gave old-school, boring (and often ineffective) exercises and put the client on a machine for twenty minutes, Cassie and the team at Taylored Training decided to do something about it.

Cassie believes that physiotherapy should be hands-on, manual, and exercise-based, with clients seeing noticeable improvements each and every session. She works closely with the coaching team, and together they show that the key to successful treatment is the integration of physiotherapy with improved physical fitness, allowing clients to succeed in achieving long-term success.

Cassie received her Masters of Science in Physical Therapy as well as her Bachelor of Physical and Health Education from Queen’s University in Kingston, Ontario. While at school, Cassie was heavily involved with university level athletics, working as a therapist with the varsity teams at the Royal Military College of Canada and Queen’s University.

Since that time, Cassie continues to work with both recreational and competitive athletes at the local, university, provincial, national, and international levels. Cassie also has a passion for continued learning and has attended countless conferences, seminars, and courses in topics including functional rehabilitation, soft tissue release, manual therapy, and a variety of other assessment and treatment techniques.

In addition to her work, Cassie has also undergone her own physical transformation, losing over 100lbs. Being passionate about health and fitness, she wanted to make sure she was practicing the life she so strongly believed in. She therefore knows the importance of a good fitness program and qualified coaches to help you reach your goals.

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