When Imaging Helps… and When It Gets in the Way of Recovery
Hip pain. Knee pain. Shoulder pain.
One of the first questions patients ask is simple: “Do I need a scan?”
And if we’re honest, sometimes the system nudges us in that direction too.
But step back for a moment. Because the issue isn’t imaging itself.
It’s how and when we use it.
Imaging isn’t the problem. Overuse is.
There’s no debate here. Imaging has a clear role in MSK care: Red flags. Unclear diagnosis. Pre-surgical planning etc. But outside of those situations, do they actually add value in patient care or outcomes?
A UK primary care study looking at MSK MRI use found that only around 5% of scans were clearly indicated, and just 16% of patients had received appropriate prior therapy before imaging.
That’s not a small gap. That’s a pathway issue.
What actually happens when imaging comes too early
On paper, a scan feels like progress. In reality, it often creates friction. You start to see:
- Incidental findings that don’t match symptoms
- Labels that increase patient anxiety
- A shift away from movement and function
In that same UK study, imaging rarely changed treatment. But it often triggered additional referrals and longer pathways.
Another NHS-based review of knee MRIs found that around 76% were inappropriate, with patients then waiting weeks before reaching the next step in care.
So instead of speeding things up, imaging can quietly slow everything down.
The hidden cost isn’t just financial
We often talk about the cost to the system, but the bigger cost is behavioural. Once a patient sees a scan report, the narrative changes.
“Something is damaged.”
“I need fixing.”
“Movement might make it worse.”
Even when findings are age-related or clinically irrelevant. That shift matters. Because recovery in MSK isn’t just structural. It’s behavioural. And early imaging can unintentionally move patients away from active recovery.
Most MSK conditions don’t need imaging to start treatment
This is the part that gets missed. The majority of MSK presentations seen in primary care can be diagnosed and managed clinically. Not perfectly, but safely and effectively. And importantly, without delaying treatment.
Guidelines consistently support:
- Early advice
- Movement-based rehab
- Self-management strategies
Imaging doesn’t sit at the start of that pathway. It sits further down, when it’s actually needed.
So what works better?
It’s not about removing imaging instead getting the sequence right. When patients are seen early by MSK clinicians:
- Diagnosis is clarified
- Red flags are screened
- A clear plan is given
- Movement starts earlier
And often, the need for imaging reduces naturally. Not because we’re avoiding it. But because it’s no longer necessary.
What this means for primary care pathways
This is where it becomes a system conversation. Because imaging behaviour is rarely just about individual decisions. It reflects how the pathway is set up.
If access to MSK expertise is delayed, imaging becomes the default next step.
If access is early and clear, rehabilitation becomes the starting point.
That shift alone changes:
- Demand
- Waiting times
- Patient experience
- Downstream referrals
The HealthPlus perspective
We see imaging as part of the pathway. Not the starting point.
Our focus is simple: Get the right patient- to the right clinician – early enough to make a difference
Because when that happens patients move sooner, confidence improves and unnecessary steps start to fall away. Including imaging that was never needed in the first place
Final thought
A scan can give you an image. But it doesn’t give you a plan.
And in MSK care, the plan is what changes outcomes.
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References:
– Sajid IM, Parkunan A, Frost K. Unintended consequences: quantifying the benefits, iatrogenic harms and downstream cascade costs of musculoskeletal MRI in UK primary care. BMJ Open Qual. 2021 Jul;10(3):e001287. doi: 10.1136/bmjoq-2020-001287. PMID: 34215659; PMCID: PMC8256731.- Khan MM, Pincher B, Pacheco R. Unnecessary magnetic resonance imaging of the knee: How much is it really costing the NHS? Ann Med Surg (Lond). 2021 Aug 28;70:102736. doi: 10.1016/j.amsu.2021.102736. PMID: 34603711; PMCID: PMC8463827.-Mukkamala L, Schaffer SL, Weber MG, Wilde JM, Rosen AS. Is Magnetic Resonance Imaging Overused Among Patients Undergoing Total Knee Arthroplasty? J Am Acad Orthop Surg Glob Res Rev. 2024 Oct 21;8(10):e24.00258. doi: 10.5435/JAAOSGlobal-D-24-00258. PMID: 39432816; PMCID: PMC11495707.-Shah M, Iyengar A. Optimising Imaging Pathways for Musculoskeletal Presentations in Primary Care: A General Practice Perspective. Apollo Medicine. 2026;23(1):30-34. doi:10.1177/09760016251385807– Parkar, A.P., Adriaensen, M.E.A.P.M. ESR essentials: MRI of the knee—practice recommendations by ESSR. Eur Radiol 34, 6590–6599 (2024). https://doi.org/10.1007/s00330-024-10706-7
– Koenig S, Morcos G, Gopinath R, Wang K, Henn F 3rd, Leong NL. Is MRI Overutilized for Evaluation of Knee Pain in Veterans? J Knee Surg. 2023 Feb;36(3):305-309. doi: 10.1055/s-0041-1733880. Epub 2021 Sep 2. PMID: 34474493; PMCID: PMC9925228.- Petron DJ, Greis PE, Aoki SK, Black S, Krete D, Sohagia KB, Burks R. Use of knee magnetic resonance imaging by primary care physicians in patients aged 40 years and older. Sports Health. 2010 Sep;2(5):385-90. doi: 10.1177/1941738110377420. PMID: 23015964; PMCID: PMC3445052.- Emery DJ, Shojania KG, Forster AJ, Mojaverian N, Feasby TE. Overuse of Magnetic Resonance Imaging. JAMA Intern Med. 2013;173(9):823–825. doi:10.1001/jamainternmed.2013.3804- Sherman SL, Gulbrandsen TR, Lewis HA, Gregory MH, Capito NM, Gray AD, Bal BS. Overuse of Magnetic Resonance Imaging in the Diagnosis and Treatment of Moderate to Severe Osteoarthritis. Iowa Orthop J. 2018;38:33-37. PMID: 30104922; PMCID: PMC6047403.- Muhammad Murtaza Khan, Bethan Pincher, Ricardo Pacheco. Unnecessary magnetic resonance imaging of the knee: How much is it really costing the NHS?, Annals of Medicine and Surgery, Volume 70, 2021, 102736, ISSN 2049-0801, https://doi.org/10.1016/j.amsu.2021.102736.
