"I know that I know nothing."​
-Socrates

Most patients do not need imaging.

A simple plan focusing on exercises, pain guidelines, and sensible training progressions is enough to get them back to training without needing further information.

It has become common for sports medicine physicians to discuss how asymptomatic findings are present in all types of athletes.

• ​BSIs in pain-free runners​
• ​Rotator cuff tears in athletes​
• ​Asymptomatic herniated discs in football players​

But there is a trend now amongst providers to only highlight the downsides of diagnostic imaging, forgetting to mention how additional testing helps provide the best patient care.

If you're not sure, get a picture

When someone enters a clinic with a presentation that doesn't sit right with you, get more information.

Imaging can provide clarity when dealing with uncertainty.

I'm pretty good at figuring out if a patient has a bone stress injury. But, I can't truly know if someone's weight-bearing hip pain is coming from a femoral neck stress fracture, labral tear, or an osteosarcoma without imaging.

Here are three times when imaging helps me do my job.

The case of the cheesy fingers

Back in 2021, I got a text from my wife saying our 5-year-old had fallen and hurt his arm. My son was overzealous eating some nachos, and his cheesy fingers caused him to slip off the monkey bars and landed on his outstretched arm.

A few hours later, I walked out of the local walk-in ortho clinic with my son fitted for a bright orange cast for a newly diagnosed radial head fracture.

Imaging told us the injury and what to do about it. 3 weeks in a waterproof cast and my son was back to being a kid.

The case of the scared long jumper

Fast forward a few years, and my now 3rd grader got spooked on the steps, jumping down an entire flight, hitting with a thud on his ankle.

He was unable to weight-bear following his missed landing, meaning we headed back to that same walk-in clinic. Luckily, this time his X-ray came back clean, and he was able to play in a basketball tournament a few days later.

Imaging ruled out a fracture and allowed him back to sport quickly.

The case of things not adding up

I recently had a second opinion on a pelvic stress reaction. The athlete had been working with a colleague for several months after the injury, but was still experiencing symptoms.

During their exam, direct pressure on the anterior pelvis, resistance tests to the hip and trunk, and weight-bearing testing still reproduced their symptoms. While BSIs around the pelvis are notorious for slow healing, I would expect improvement at this point in recovery.

I recommended they check back in with their doctor for a potential follow-up MRI. The second MRI revealed no healing at the injury site.

It's typical to get a follow-up MRI before starting a return-to-run progression for a high-risk BSI. But a second can also help when progress is stalled.

Most of the injuries I treat don't require the time and cost of additional testing. But imaging is still an essential part of clinical practice, especially if you see patients directly.

If you want a 30,000-foot view on imaging and BSIs, check out the article and research summary I included at the bottom of this email.