5 Orthopedic Problems That May Be Normal

When Abnormal May Be Normal

Not every test finding is unexpected.  As we age, many "abnormal" findings may be perfectly normal--or at least expected.  When we age, we may get wrinkles in our skin, or notice a few grey hairs (or maybe less hair), but we don't consider these changes "abnormal."  They are just normal changes that occur as we age.

Similarly, many findings in MRI reports and x-rays obtained by your orthopedic surgeon may not be unexpected.  While these findings may represent a source of pain or a cause of disability, they may also be entirely irrelevant to the cause of your problem.  That's why orthopedics is not as easy as just reading a test report--your doctor uses symptoms, examination findings, test results, and other information to help you determine the source of pain.

1
Disc Bulging

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A bulging disc is a common finding on MRIs.  A very well known study performed in 1989 gathered about 70 patients to have an MRI of their spine.  These patients have no back or spine problems, they just had an MRI done for purposes of this study.  They found bulging discs in over a third of 20-somethings, and in almost everyone over the age of 60.  A follow-up of these patients 10 years later found that the findings on MRI did not help to predict the likelihood of back pain.

Many people are surprised to hear that bulging discs are common, in fact, many people consider this a normal part of aging.  The most surprising fact is how normal this finding is even in someone's 20s.  The vast majority of back pain has origins outside of a bulging disc, even if that finding is seen on an MRI.

Source:

Boden SD, et al. "Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation." J Bone Joint Surg Am. 1990 Mar;72(3):403-8.

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2
Rotator Cuff Tears

shoulder pain
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Rotator cuff tears are incredibly common as people age.  In fact, in an elderly population, over the age of 80 years, over 70% of people have a torn rotator cuff.  Even in people who are younger, rotator cuff tears can occur without pain or symptoms.  Most often, in patients under the age of 40, a rotator cuff tear is a problem, but as people age, they become expected.   Because of this, not every rotator cuff tear requires surgical treatment, and often non-operative treatment can alleviate the symptoms associated with a torn rotator cuff.

Source:

Yamaguchi K, et al. "The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders." J Bone Joint Surg Am. 2006 Aug;88(8):1699-704.

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3
SLAP Tears

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SLAP tears are notorious for being seen on MRI tests, but not being clinically significant.  Most orthopedists agree that many of the MRIs that show a SLAP tear are actually just normal variants.  One recent study put together the findings of almost 500 patients who had an MRI and shoulder arthroscopy.  Of those patients, 121 had an MRI showing a SLAP tear, but only 44 were found to have a SLAP tear at the time of shoulder arthroscopy.

The critical piece is for your surgeon to combine the findings not only on the MRI, but on your physical examination.  Only when there are clinical signs of a SLAP tear is the diagnosis likely.

Source:

Sheridan K, et al. "Accuracy of magnetic resonance imaging to diagnose superior labrum anterior-posterior tears" Knee Surg Sports Traumatol Arthrosc. 2014 Jul 2.

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4
Hip Labral Damage

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It is not uncommon for athletes to complain of symptoms of hip and groin pain.  Up until recently, these symptoms were often attributed to muscle injuries and strains.  With the recent advent of hip arthroscopy, doctors have begun to look at the hip joint as a source of pain, specifically the hip labrum.

Now it seems that any athlete with hip pain is being diagnosed with a labral tear.  Part of the problem is that while we are learning that the hip labrum can be a source of pain, having a tear of the labrum does not mean that is necessarily the source of pain.  Surgeons are still trying to learn which patients may benefit from arthroscopic hip surgery, but not every labral tear requires this treatment.

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5
Bunions

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Bunions are something many people worry about, but almost a third of people have.  Bunion surgery should only be considered for people who have painful bunions that have not improved despite simple treatments such as modifications in footwear.  Bunion surgery has potential complications, and is not considered a cosmetic procedure.

Bunions are extremely common, and usually the result of footwear.  While some people seem to be genetically prone to developing bunions, the problem is found almost exclusively in parts of the world where people wear Western footwear.  In parts of the world where footwear is different, bunions are extremely uncommon.

Coughlin MJ, Jones CP "Hallux valgus: demographics, etiology, and radiographic assessment" Foot Ankle Int. 2007 Jul;28(7):759-77.

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