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What scans find in people without pain

Scans often show changes in people who have no pain at all. Before you link a scan finding to a patient’s symptoms, it helps to know how common that finding is in people without symptoms. One example per body region is below.

These figures come from people with no symptoms in published studies. They describe groups, not the person in front of you. A finding that is common without pain can still be the cause of pain; the scan has to fit the history and examination.

Lower back

In people with no back pain, disc bulges were seen on scans in about 30% of 20-year-olds and 84% of 80-year-olds. Disc degeneration rose from 37% to 96% across the same ages.

Source: Brinjikji W, et al. AJNR Am J Neuroradiol 2015;36(4):811-816 (systematic review, 33 studies, 3,110 people; Table 2). The figures are estimates from a statistical model, and the oldest age groups rest on few people (Table 1).

Neck

Across studies of healthy people who had no medical reason for a neck MRI, about 1 in 4 (24%) had the spinal cord pressed on by surrounding structures. It was 7% in studies with an average age of 60 or under and 35% in studies with an average age over 60. Rates also differed a lot between studies.

Source: Smith SS, Stewart ME, Davies BM, Kotter MRN. Global Spine J 2021;11(4):597-607 (systematic review; 11 studies, 3,686 people; 95% CI 12.4-36%; Figures 3 and 4A). Split by each study's average age, not by each person's age.

Shoulder

On ultrasound, rotator cuff tears were found in 13% of pain-free people in their 50s and 51% of those aged over 80.

Source: Tempelhof S, et al. J Shoulder Elbow Surg 1999;8(4):296-299 (411 volunteers aged 50 and over). Abstract source only.

Hip

About half (54%) of people without hip pain had a labral tear on MRI.

Source: Heerey JJ, et al. Br J Sports Med 2018;52(9):581-593 (systematic review; pooled from 8 studies; 95% CI 41-66%). The studies were mostly of younger adults, so there are no figures by age.

Knee

Meniscal tears were seen in 4% of knees without symptoms or past injury in studies with an average age under 40, and in 19% of knees in studies with an average age of 40 or over. Cartilage defects rose from 11% to 43% of knees.

Source: Culvenor AG, et al. Br J Sports Med 2019;53(20):1268-1278 (systematic review, 63 studies, 5,397 knees; Figures 2 and 3). Split by each study's average age.

Achilles tendon

Studies of people without symptoms found tendon changes in anywhere from 0% to 80% of people, depending on the study. The figures varied too much to combine.

Source: Docking SI, et al. J Orthop Sports Phys Ther 2021;51(5):232-252 (91 studies).

Full tables by age band for every region, with every study listed, are in Rule It In, Rule It Out.

See also: How common is it? Starting probabilities by setting.