Imaging Findings Associated With Osteoarthritis Are Common in Dancers, and Are Rarely Symptomatic: A Systematic Review With Meta-Analysis
Article Summary
I thought this article was worth sharing. It is a systematic review with meta-analysis on the prevalence of osteoarthritis on imaging vs having symptoms for professional and post-professional dancers.
Ankle OA
Prevalence: 41%
Symptomatic: 2%
Hip OA
Prevalence: 19%
Symptomatic: 8%
First MTP OA
Prevalence: 59%
Symptomatic: 3%
Takeaways
This is more evidence that damage does not predict pain. It’s the radiologist’s job to point out everything they can see on the image in their report, but most (if not all) of what they list in their report is not the source of the problem – it may be contributing to the problem, but contribution does not mean cause.
Most of the time, if we remove everything we can control from the equation (joint, muscle, fascia, compensation, load, pacing, inflammation/edema, stress, lack of sleep, poor nutrition, etc.), the remaining tissue damage problem is not perceived by the brain as enough of a threat to cause the pain by itself.
Conclusion
Do not let an image dictate your clinical judgement, or let a patient perseverate on it. These are wrinkles on the inside. We see them, but they don’t cause pain by themselves.
✓ Validate the patient’s concern
“Those words sound really scary when you read them. I’m sure I would feel the same way if I was in your shoes.”
✓ Ask for permission to discuss it further
“Would you like to know more about what your report means?”
They never say “no.”
✓ Explain that most things we see on imaging that say “mild” or “moderate” do not cause the problem on their own
Things that say “severe” may be threatening enough to cause the pain on their own, but it depends on the tissues around it and their activity level
Many studies have shown severe tissue problems that cause no pain in the patient
✓ Load. The. Tissue.
✓ Never bring up the image again, unless the patient shows more concern about it
