Most people who come to the office with a scan have already read the report, and the report usually lists several findings: a bulging disc, a degenerative tear, a labral abnormality, a partial-thickness tendon tear, cartilage thinning. Those words describe what the radiologist saw. They do not, on their own, say what is causing the pain, and they do not say whether anything needs to be done about it.
The reason is well documented. When researchers scan large groups of people who have no symptoms at all, they find the same list. The studies summarized on this page, drawn from peer-reviewed studies of people without symptoms, show that disc degeneration, meniscal tears, rotator cuff tears, hip labral tears and many other findings are present in a large share of pain-free adults, and that nearly all of them become more common with each decade of life. In many joints the finding is closer to a normal feature of an adult body than to an injury.
Dr. O'Donnell uses that literature every day, in two directions. It means an abnormal scan in a patient with no symptoms is usually left alone. It also means that in a patient who does have symptoms, the finding on the scan has to be matched against the history and the examination before it is blamed, and that surgery is recommended for the problem the patient actually has, not for the report. The sections below give the figures joint by joint. Each condition page on this site carries the same information in more detail.
Headline figures
A few examples from large studies of people who had no pain when they were scanned. The pattern is the same in every joint: the finding is common, and it becomes more common with age.
| Finding | People with no symptoms | Age trend | Source |
|---|---|---|---|
| Lumbar disc degeneration on MRI | 37% of 20-year-olds; 96% of 80-year-olds | Rises every decade | Systematic review of 33 studies, 3,110 people |
| Cervical disc bulging on MRI | 87.6% of 1,211 volunteers aged 20–70 | Rises with age | Prospective volunteer study, 1,211 people |
| Full-thickness rotator cuff tear on ultrasound | 23% overall; 51% of those over 80 | 13% in the 50s to 51% in the 80s | Ultrasound study of 411 shoulders |
| Meniscal tear on knee MRI | 19% of women aged 50–59 to 56% of men aged 70–90; 61% of tears caused no symptoms | Rises with age | Community MRI study, 991 people |
| Any abnormality on knee MRI, age 50 and over | 89% of 710 people without radiographic arthritis | — | Community MRI study, 710 people |
| Hip labral tear on MRI | 69% of 45 volunteers (mean age 38) | Rises with age | Blinded MRI study, 45 volunteers |
| Cam morphology of the hip | 37% of asymptomatic hips; 55% in athletes | — | Systematic review, 2,114 hips |
| Thumb base (CMC) arthritis on X-ray | 91% of people over 80 | Rises with age | Radiographic series of adult hands |
Spine Joint overview →
Degenerative Disc Disease
Wear in the discs of the spine is close to universal with age, and it shows up on MRI in people who have never had back pain. In large studies of pain-free adults, disc wear was already present in more than a third of 20-year-olds and in almost everyone by 80. Bulging discs and worn facet joints (the small joints at the back of the spine) follow the same curve. Rescanned years later, pain-free volunteers had almost all progressed on the scan with no change in symptoms.
Full figures and references on the Degenerative Disc Disease page →
Disc Herniation
Bulging and herniated discs are common in people with no back pain. In studies of pain-free adults, about half had a bulging disc and roughly one in four had a herniation, and both become more common with age. Herniations also shrink on their own, and the larger ones are the most likely to be reabsorbed. A year after an episode of sciatica, the herniation is still visible in about a third of people whether or not they have recovered.
Sciatica
The disc findings usually blamed for sciatica are common in people who have never had leg or back pain. In studies of pain-free adults, roughly one in four had a herniation, and the share rises with age. The herniations that do cause sciatica usually shrink without surgery. Most people with sciatica are much better within a year, and the herniation is often still visible whether they have recovered or not.
Stingers / Burners
A stinger is diagnosed from the story and the examination, not from a scan, and the two findings that turn up on imaging afterward are common in athletes who never had one. The first is a narrow spinal canal in the neck: roughly one in three football players playing without symptoms measure as having one, and most never have a stinger. The second is ordinary wear: bulging discs in the neck are found in nearly nine out of ten healthy adults.
Full figures and references on the Stingers / Burners page →
Shoulder Joint overview →
Rotator Cuff Tear
Rotator cuff tears are common in shoulders that have never hurt. In large studies of people with no shoulder symptoms, about one in four had a tear on their scan. The older you are, the more likely the finding, and roughly half of people over 60 have one. Followed for several years, about half of these painless tears stayed the same size and stayed painless.
Shoulder Impingement & Bursitis
The findings usually reported as impingement or bursitis are the norm in middle-aged people with no shoulder pain. In studies of men in their forties to sixties with no symptoms, nearly every ultrasound showed something: most had a thickened bursa, the fluid-filled cushion under the tip of the shoulder blade, and about one in five had a partial cuff tear. A curved or hooked shape of the bone above the cuff is seen in almost everyone over 70. These changes are part of normal aging.
Full figures and references on the Shoulder Impingement & Bursitis page →
AC Joint Injury
Wear in the AC joint, the small joint where the collarbone meets the top of the shoulder, shows up on almost every adult shoulder MRI. In large studies of people with no shoulder pain, roughly four out of five scans showed arthritis-type changes there, and after 70 the finding was nearly universal. Most people who have it never notice it.
Labral / SLAP Tear
The labrum is the rim of cartilage around the shoulder socket, and tears in it are reported on the MRIs of many shoulders that have never hurt. In adults in their late forties and fifties with no shoulder pain, radiologists read a tear at the top of the labrum, a SLAP tear, in more than half of shoulders. Most professional pitchers with no symptoms have an abnormal-looking labrum. The older you are, and the more you have thrown, the more likely the finding.
Full figures and references on the Labral / SLAP Tear page →
Shoulder Instability
The findings linked to instability are common in shoulders that are stable and have never dislocated. Most professional pitchers with no symptoms have an abnormal-looking labrum, the cartilage rim around the socket, on MRI, and elite athletes with such findings, followed for five years, did not develop problems. Among young adults who do not play sports, about one in ten has a labral finding; by the late forties and fifties it is more than half.
Full figures and references on the Shoulder Instability page →
Biceps Tendinitis / Tear
Damage to the long head of the biceps, the tendon that runs up the front of the shoulder into the joint, is fairly uncommon on the scans of people with no shoulder pain. What is common is the wear around it. In studies of middle-aged men with no symptoms, nearly every ultrasound showed a thickened bursa or an arthritic AC joint, while only a few showed a damaged or slipped biceps tendon. The older you are, the more background wear to expect.
Full figures and references on the Biceps Tendinitis / Tear page →
Shoulder Arthritis
Arthritis in the shoulder is common on the scans of people who are not complaining about it. Large reviews of MRI in adults with no shoulder pain suggest that somewhere between a third and three-quarters of shoulders show wear in the ball-and-socket joint, and on plain X-rays of a general population over 40, about one in six had visible arthritis. The older you are, the more likely the finding, and the odds climb steeply through the sixties and seventies.
Full figures and references on the Shoulder Arthritis page →
Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder is diagnosed in the exam room, not on a scan. What the MRI or ultrasound shows is mostly the ordinary wear of middle age, which would be there whether the shoulder was stiff or not. In studies of middle-aged men with no shoulder pain, nearly every ultrasound showed a thickened bursa, a worn cuff tendon or an arthritic AC joint, and about one in five had a partial cuff tear. None of that explains a shoulder that has lost its motion.
Full figures and references on the Frozen Shoulder (Adhesive Capsulitis) page →
Elbow Joint overview →
Tennis / Golfer's Elbow
Tennis elbow and golfer's elbow are diagnosed in the exam room. Imaging is not needed, and what it shows is common in people with no pain. In adults with no elbow symptoms, about one in ten elbows showed the extra blood flow in the tendon often cited as a sign of damage, and bone spurs at the tendon attachment rose from about one in four people in their twenties to three in four of those over 70. How bad the MRI looks does not track how bad the elbow feels.
Full figures and references on the Tennis / Golfer's Elbow page →
UCL Injury
In throwing athletes the UCL, the ligament on the inner side of the elbow, adapts to load, and a pitcher's elbow looks abnormal by ordinary standards even when it has never hurt. In professional pitchers with no symptoms, the throwing-arm ligament is thicker than the other side, and on MRI the great majority show thickening, uneven signal or apparent gaps in it. About half of symptom-free youth players around age 11 show what a radiologist would call a ligament injury. Pitchers who later tore the ligament did not look different at the start.
Cubital Tunnel Syndrome
Cubital tunnel syndrome, a pinched nerve at the inner elbow, is diagnosed from your symptoms and the exam. Ultrasound and nerve tests support it but do not make it. In adults with no symptoms, roughly one in five ulnar nerves measured above the usual size cutoff on ultrasound, and a nerve that conducts slowly across the elbow also turns up in people with no complaints. The nerve measures larger in men, in heavier people and after about age 40.
Full figures and references on the Cubital Tunnel Syndrome page →
Elbow Arthritis
True wear-and-tear arthritis of the elbow is uncommon, and there is no large study of symptom-free elbow X-rays to give a firm figure. What the evidence does show is that bony change around the elbow builds up with age in people who have no elbow pain: bone spurs at the outer elbow were present in about one in four people in their twenties and three in four of those over 70. A spur on the X-ray of a 60-year-old is expected rather than diagnostic.
Hand & Wrist Joint overview →
Carpal Tunnel Syndrome
Carpal tunnel syndrome is diagnosed from the symptoms and the examination. A nerve test can support the diagnosis, but a positive result on its own does not make it. In a large study of adults with no hand symptoms, roughly one in five still tested positive for a slowed nerve at the wrist. Some pressure on the nerve is common in hands that feel fine.
Full figures and references on the Carpal Tunnel Syndrome page →
TFCC Tear
The TFCC is the cushion of cartilage on the little-finger side of the wrist. Wear and small tears in it are part of normal aging, and they show up on MRI in many wrists that have never hurt. In studies of people with no wrist pain, roughly one in seven under 30 had a TFCC abnormality, and about half of those over 70 did. Most of these tears never cause a problem.
Thumb Arthritis
Arthritis at the base of the thumb is one of the most common X-ray findings in the aging hand, and most people who have it never seek treatment for it. Wrist X-rays taken for other reasons show it in a rising share of people from their forties onward, and in roughly nine out of ten people over 80. In one large group with the finding, only a handful had ever had surgery for it.
Hip Joint overview →
Hip Labral Tear
The labrum is the ring of cartilage around the rim of the hip socket. Tears in it are among the most common findings on hip MRI in people with no hip pain. In studies of pain-free volunteers, about two out of three hips showed a labral tear, and even among young adults in their twenties, more than one in three did. The finding becomes more common with age.
Femoroacetabular Impingement
The bone shapes linked to hip impingement, a bump on the ball (cam) or a deep rim on the socket (pincer), are common in hips that have never hurt. In large studies of young adults with no hip pain, more than one in three had a cam shape, and it was more common still in athletes. When pain-free hips with these shapes were followed for nearly twenty years, most never developed arthritis.
Full figures and references on the Femoroacetabular Impingement page →
Hip Arthritis
Hip X-rays and hip pain match poorly in both directions. In large population studies of adults over 50, roughly four out of five hips with arthritis on the X-ray were not painful on most days, and most hips that did hurt often showed no arthritis on the film. These findings become more common with age, and cartilage wear shows up on MRI in pain-free people too.
Greater Trochanteric Bursitis
The outer-hip findings labeled bursitis or gluteal tendinopathy on MRI are found in most hips that have never hurt. In one large MRI study, nearly nine out of ten hips with no outer-hip pain showed the same changes around the bony point of the hip seen in people with pain, and about half showed wear in the gluteal tendons. Tendon wear, not a swollen bursa, is usually what is there, and it becomes more common with age.
Full figures and references on the Greater Trochanteric Bursitis page →
Hamstring Strain / Tear
A hamstring strain is a fresh injury, so the imaging question is which findings are new. MRI of people with no hamstring symptoms often shows wear where the tendons attach to the sitting bone, more so with age, and small partial tears are not rare. The scan also lags behind recovery: most athletes cleared to play still show changes.
Full figures and references on the Hamstring Strain / Tear page →
Knee Joint overview →
Meniscus Tear
Tears of the meniscus show up on MRI in a lot of knees that have never hurt. In large studies of adults over 50 with no knee pain, roughly one in three had a meniscal tear on their scan, and the share climbs with every decade. Most of these tears are the result of years of use, not a single injury, and the majority of people who have one never notice it.
Cartilage Injury
Worn or damaged cartilage is one of the most common things an MRI finds in knees that do not hurt. In large studies of adults with no knee pain and no injury, about one in four had a cartilage defect, and among older adults with normal X-rays, most had some cartilage damage on MRI. Many professional basketball players have cartilage wear under the kneecap and play without pain.
Knee Arthritis
Knee X-rays and MRIs match symptoms poorly. In a large national survey, fewer than half of the adults with arthritis on their knee X-ray had any knee pain. MRI picks up even more: among adults over 50 with normal X-rays, roughly 9 out of 10 had at least one arthritis-type change, nearly as often in painless knees as in painful ones.
Patellofemoral Pain Syndrome
Pain at the front of the knee matches the scan poorly. Softening or wear of the cartilage under the kneecap ("chondromalacia") is common in people with no pain at all. Young adults with kneecap pain and those without show small cartilage defects and bone bruising under the kneecap just as often. Among professional basketball players with no knee pain, about one in three had a cartilage lesion under the kneecap.
Full figures and references on the Patellofemoral Pain Syndrome page →
MCL (Collateral Ligament) Injury
Fluid or bright signal around the inner (medial) collateral ligament is a common MRI finding, and it does not by itself mean the ligament is injured. In people who were never injured, it shows up in most knees with arthritis on the inner side and in very few without it. In large studies of adults with no knee pain, only about one knee in thirty showed a partial tear of any ligament.
Full figures and references on the MCL (Collateral Ligament) Injury page →
Patellar Tendon Tear
A complete tear of the patellar tendon is a sudden, painful injury and does not hide on a scan. What causes confusion is wear or partial tearing in a tendon that has never hurt. In young athletes with no knee pain, about one in four patellar tendons looks abnormal on ultrasound. Most of these never become sore, and about half return to normal within a year or two.
Full figures and references on the Patellar Tendon Tear page →
Patellar Instability
A kneecap dislocation is something that happens to a person, not something a scan finds. What scans find are the shapes that make a dislocation more likely: a shallow groove for the kneecap to sit in (trochlear dysplasia) and a kneecap that sits high or tilts. Roughly one adult knee in ten has a markedly shallow groove, and most of those knees have never given trouble.
Full figures and references on the Patellar Instability page →
Tibial Plateau Fracture
A tibial plateau fracture is a sudden injury diagnosed on X-ray or CT; nobody has one without knowing it. What causes confusion is a "bone bruise" on MRI, which is common in knees that have never been injured. About half of adults over 50 with normal knee X-rays have one, and it becomes more frequent with age.
Full figures and references on the Tibial Plateau Fracture page →
Foot & Ankle Joint overview →
Achilles Injury
Changes in the Achilles tendon on ultrasound or MRI are common in people who have no Achilles pain. Thickening, bright signal and new blood vessels growing into the tendon all show up in people with no symptoms; among healthy long-distance runners, about one in three had new blood vessels in the tendon.
Ankle Sprain / Instability
Ligament changes and bone bruising on an ankle MRI are common in ankles that have never given trouble. Among marathon runners with no ankle symptoms, close to half showed damage to the main outer ankle ligament and a similar share had a bone bruise. After a fresh sprain with normal X-rays, about one person in four had a bone bruise on MRI, and it made no difference to how the ankle recovered.
Full figures and references on the Ankle Sprain / Instability page →
Osteochondral Lesion
A damaged patch of cartilage and bone on the top of the ankle bone (an osteochondral lesion of the talus) is found in some people with no ankle symptoms, and many of these patches cause no trouble for years. Among people with a known lesion who had both ankles scanned, about one in seven had a matching lesion in the other ankle, and most of those were silent.
Full figures and references on the Osteochondral Lesion page →
Plantar Fasciitis
Heel spurs and a thickened plantar fascia are both common in people who have never had heel pain. Among older adults in the community, more than half had a heel spur on X-ray, and most of those had never had a sore heel. On ultrasound, a small share of pain-free feet have a fascia thicker than the usual cutoff for plantar fasciitis.
How Dr. O'Donnell decides whether a finding is the cause of pain
The order of evidence is history, examination, imaging, and then, where the answer is still uncertain, a targeted test. The history has to fit: the mechanism, the onset, the activities that reproduce the pain and the ones that do not. The examination has to localize to the same structure the scan is describing, using the specific provocation and strength tests for that joint. The finding on the scan has to be on the correct side, at the correct level, and of a type that plausibly produces the symptom pattern; a small disc bulge on the left does not explain right-leg pain, and a partial-thickness cuff tear does not explain a shoulder that has lost passive motion.
When those three lines of evidence agree, the diagnosis is usually settled. When they do not, Dr. O'Donnell uses a diagnostic anesthetic injection under ultrasound or fluoroscopic guidance to test a single structure, compares the current scan with any earlier imaging to separate new findings from old ones, orders nerve conduction studies where a nerve is in question, and looks at the response to a proper course of therapy. A finding that is common in pain-free people, that does not match the examination, and that does not respond to an anesthetic block is treated as background.
Surgery is recommended when the symptoms, the examination and the imaging point to the same structure, when the natural history of that problem favors an operation, and when non-operative treatment has been tried where it is appropriate or is not a reasonable option. A finding on an MRI, X-ray, ultrasound or nerve study is not by itself a diagnosis, and it is not by itself a reason for surgery.
Frequently asked questions
My MRI report lists several abnormalities. Does that mean something is wrong?
Not necessarily. Studies of people with no symptoms show that most adults over 40 have at least one abnormality on a knee, shoulder, hip or spine MRI, and the number rises with age. What matters is whether a finding matches your symptoms and your examination. Many findings on a report are age-typical and need no treatment.
Do disc bulges and herniations need surgery?
Most do not. Disc bulges are present in about half of people who have never had back pain, and most symptomatic herniations improve without surgery over weeks to months, with many shrinking on follow-up imaging. Surgery is considered for persistent nerve compression with matching weakness or pain that has not responded to time, therapy and, where appropriate, injections, or for the rare emergency of bowel or bladder involvement.
If a tear shows on my scan and I have pain, is the tear the cause?
Often, but not always. The tear has to be on the correct side, in a structure that the examination also identifies as painful, and of a type that fits the symptoms. Where that is unclear, an anesthetic injection into the structure, comparison with older imaging or the response to therapy is used to confirm or exclude it before any operation is discussed.
Should I get an MRI before my first appointment?
Usually not. Dr. O'Donnell examines the joint and takes X-rays first and orders an MRI when the result would change treatment. If you already have imaging, bring it or upload it through mymedicalimages.com so it can be read alongside the examination rather than in isolation.
