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History? What history? An imaging foul [premium post]

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Almost all of us have looked at medical imaging results and wondered how seriously to take them. Today I have an amusing cautionary tale, a case study that leaves no doubt about just how misleading pictures of the inside of your body can be.

My mother has had some significant shoulder problems this year — frozen-shoulder-esque, but with some odd signals that have made that diagnosis a little uncertain (as it so often is). She recently got some imaging done. The results were noteworthy in two ways.

First, the report literally and laughably has a question mark next to the heading “history,” as in the clinical history, the story of the case. In musculoskeletal medicine, for almost anything more subtle than a major fracture, imaging is routinely futile or misleading, a fire hose of red herrings and ambiguity— and that’s with the clinical context! Without it? Fuhgeddaboudit.

In this case, of course, my mother discussed the results with her physician, and he did know the clinical history, but it’s still a bit appalling: “history” is a standard part of radiology reports for a reason.

And we’re about to see one of those reasons demonstrated rather well.

The second bizarre thing on the report

The magic flesh-penetrating sound waves revealed …

…something fascinating. But the rest of post is for paid subscribers only. Sign-up now for access, plus all past premium posts, five others so far, since the launch of premium subscriptions in late August.

This is the smallest of my premium posts so far, just an additional 500 words to wrap it up, a couple more minutes of reading. The remainder delivers the surprising result, of course, plus commentary and perspective on what it all means, relevant to many patients and professionals trying to interpret imaging results. Good owner’s manual stuff.