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Clear X-Ray doesn't equal no problem!!

Total Shoulder Replacement

X-Rays are commonly used to assist in the diagnosis of musculoskeletal pain. They are the fastest, cheapest and most accessible imaging tool available, & can be useful in checking for fractures, osteoarthritis & severe osteoporosis, & for advanced forms of cancer.

Whilst X-Rays are very good at showing up bone, they provide very little information about the surrounding soft tissues. An X-Ray will not show up any damage to ligaments, tendons, muscles, nerves or discs. If there is no damage to the bones, the X-Ray report will often state “no abnormality detected”, or NAD; But this does not necessarily mean you do not have a treatable injury!

For example, a clear X-Ray on a painful knee only rules out bony injury/degeneration as the cause of pain. It does not rule out an anterior cruciate ligament rupture, patellofemoral pain syndrome or iliotibial band syndrome, all of which can be treated with physiotherapy. Having an X-Ray to help diagnose your back pain will only help to confirm that the pain is not related to a fracture of your vertebrae. It won’t show any disc injury, which is by far the most common cause of back pain, & again, treatable with physiotherapy.

The result of an X-Ray may also be dependent on when it is performed, as some fractures cannot be seen for a couple of weeks after the injury. For example, a scaphoid fracture (of the wrist) will not always show up immediately after injury on X-Ray, & it may not actually show up at all. Any delay in treatment of this type of fracture increases the risk of poor healing & the probability of more problems later. A scaphoid fracture that is not diagnosed or left untreated can lead to severe osteoarthritis which may need to be treated surgically. So, it is a very good example of why an ‘NAD’ X-Ray does not = no problem!

Whilst there are other imaging techniques that are more sensitive & specific than X-Rays in checking for damage to the soft tissues, such as ultrasound, CT and MRI, they are not always necessary, & may be expensive. You may also have pain with no changes to the tissues.

A Physiotherapy assessment can help to develop a clinical diagnosis of your injury. If treated appropriately, you may have no need for any type of imaging at all. If we think that a diagnosis needs to be confirmed or excluded with imaging, or if we think you need to see a specialist for medical management, then we can arrange this referral for you.