When Scans Don’t Tell the Whole Story: What “Abnormal” Really Means
Modern imaging has given us incredible detail into the human body. MRI and CT scans can show every curve, line, and shadow of our joints, discs, and soft tissues. But here’s the surprising truth: many of the things reported as “abnormal” on scans are found in people who have no pain at all.
At Neurohealth Wellness on Sydney’s Northern Beaches, we often see patients worried after a scan has shown a disc bulge, hip impingement, or shoulder tear. But the science tells us something important: these findings are often a normal part of being human and don’t always explain symptoms.
Spinal Discs: Ageing Gracefully
A large 2015 review showed that disc degeneration is present in 37% of 20-year-olds and climbs steadily to 96% of people in their 80s. Disc bulges were also incredibly common, appearing in up to 87% of people over 20 – many of whom had no pain at all.
More recent studies confirm the same trend. Degenerative features such as bulges, protrusions, and annular tears are frequently seen in people without back pain. Even Schmorl’s nodes – where disc material pushes into the vertebra – are found in around 15% of symptom-free adults.
In short: disc changes are not always a “problem” but often a natural part of ageing.
The Knee and Shoulder Story
Knee scans can look worrying, but research shows that cartilage defects, meniscal tears, and even early osteoarthritis changes often appear in people with no symptoms. A high-resolution MRI study found structural “abnormalities” were surprisingly common in healthy, pain-free adults.
The same applies to the shoulder. A systematic review published in 2024 reported that 30–75% of people without painstill had imaging findings such as partial rotator cuff tears or bursitis. These may sound alarming, but they don’t necessarily equal dysfunction.
Hips: Cam and Pincer Morphology
Another area where imaging often causes confusion is the hip. Cam and pincer morphologies – bony shapes linked to femoroacetabular impingement (FAI) – are frequently picked up on scans. A large study of asymptomatic people found cam morphology in around 37% of hips and even higher rates in athletes.
Interestingly, the presence of these changes doesn’t always lead to hip pain. While certain shapes can increase the risk of future problems, many people live active, pain-free lives despite having these features on MRI.
Incidental Findings: The Unexpected “Extras”
Imaging sometimes picks up unrelated findings known as “incidentalomas”. A recent review found that about 4% of people had potentially serious incidental findings, and 12% had abnormalities of uncertain significance. Importantly, only around 20% of the “serious” ones turned out to be clinically significant after follow-up.
This shows that while advanced imaging is powerful, it can also create unnecessary worry when harmless variations are labelled as disease.
What This Means for You
At Neurohealth Wellness, we remind our patients of three key truths:
- Imaging is just one piece of the puzzle. A scan shows structure, not function. Pain and movement tell us far more about how your body is working.
- Abnormal doesn’t always mean unhealthy. Disc bulges, hip morphology, or rotator cuff changes are often part of normal ageing and adaptation.
- Context is everything. Clinical assessment, your history, and your goals matter more than a single line on a scan report.
The Neurohealth Approach
We focus on restoring function, movement, and balance – not just chasing scan findings. Whether it’s through chiropractic care, soft tissue therapy, acupuncture, hypnotherapy, or rehabilitation, our goal is to help you live without pain and prevent future issues, rather than worrying over every imperfection seen on a scan.
Final Word
Scans can be incredibly useful when combined with a thorough clinical assessment. But they don’t define your health or your future. The next time you hear “disc degeneration” or “rotator cuff tear” on a report, remember – these changes are often part of being human, not necessarily a sentence to pain.
References
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- Nakashima, H., Yukawa, Y., Suda, K., Yamagata, M., Ueta, T., & Kato, F. (2015). Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine, 40(6), 392–398.
- Culvenor, A. G., Øiestad, B. E., Hart, H. F., Stefanik, J. J., Guermazi, A., Crossley, K. M. (2019). Prevalence of knee osteoarthritis features on MRI in asymptomatic uninjured adults: a systematic review and meta-analysis. British Journal of Sports Medicine, 53(20), 1268–1278.
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- Frank, J. M., Harris, J. D., Erickson, B. J., Slikker, W., Bush-Joseph, C. A., Salata, M. J., & Nho, S. J. (2015). Prevalence of femoroacetabular impingement imaging findings in asymptomatic volunteers: a systematic review. Arthroscopy, 31(6), 1199–1204.
- Agricola, R., et al. (2013). Cam impingement of the hip: a risk factor for hip osteoarthritis. Nature Reviews Rheumatology, 9(10), 630–634.
- Morris, Z., Whiteley, W. N., Longstreth, W. T., Weber, F., Lee, Y. C., Tsushima, Y., ... & Wardlaw, J. M. (2009). Incidental findings on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ, 339, b3016.
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