Musculoskeletal: the image does not decide, the procedure has to justify itself
Three figures sum up what the literature has established. At 50, 80% of people with no pain at all have a degenerate disc on MRI (Brinjikji, AJNR, 2015). After 60, 65% of rotator cuff tears do not hurt (Minagawa, J Orthop, 2013). And subacromial decompression does no better than a placebo arthroscopy, at 6 months or at 24 (CSAW, The Lancet, 2018; FIMPACT, BMJ, 2018). A finding present in half the people your age who have no pain cannot, on its own, be a surgical indication. These figures describe populations, not one joint. Noria Health arranges a full work-up near Brussels within 24 to 48 hours.
The questions we are asked
- My back MRI shows several abnormalities, what does that prove?
- I have been offered a spinal fusion, is it necessary?
- My sciatica has lasted months, should I have surgery now?
- How long does a joint replacement really last?
- My meniscus is torn, do I need an arthroscopy?
- My shoulder has hurt for months, should it be operated on?
- A rotator cuff tear was found, is that serious?
- What do I lose by waiting?
What the figures say
| What is measured | The figure | Source and year |
|---|---|---|
| Degenerate disc on MRI in people with no pain, at 50 | 80% | Brinjikji, AJNR, 2015 |
| Rotator cuff tear in people with no symptoms, aged 70 to 79 | 45.8% | Yamamoto, J Shoulder Elbow Surg, 2010 |
| Share of cuff tears that do not hurt | 65.3% | Minagawa, J Orthop, 2013 |
| Shoulder decompression against placebo arthroscopy, at 6 months | -1.3 points, relevance threshold 4.5 | CSAW, The Lancet, 2018 |
| Meniscectomy against sham surgery, at 12 months | -1.6 Lysholm points | FIDELITY, NEJM, 2013 |
| Fusion added to lumbar decompression, success at 2 years | 72.9% against 71.4% | NORDSTEN-DS, NEJM, 2021 |
| Knee replacements still in place at 25 years | 82.3% | Evans, The Lancet, 2019 |
| Hip replacements still in place at 25 years | 57.9% | Evans, The Lancet, 2019 |
| Satisfaction after hip replacement against knee replacement | 89% against 81% | Bourne, Clin Orthop Relat Res, 2010 |
Those nine lines say one thing. In musculoskeletal medicine, three of the most commonly performed procedures have been compared against sham surgery or a less invasive alternative, and the gap turned out smaller than advertised. That does not mean never operate: knee replacement does twice as well as well-conducted non-surgical treatment, and cuff repair takes the lead at ten years. It means the procedure has to justify itself on the clinical picture and the horizon in view, not on the look of an image.
What Noria Health does in musculoskeletal care, and what it does not do
Noria Health arranges a full work-up near Brussels within 24 to 48 hours: clinical and functional examination, neurological examination and gait assessment for the spine, cuff testing and range of motion for the shoulder, weight-bearing radiographs, dynamic ultrasound, and MRI where the examination justifies it. The report is issued within 24 hours, follow-up is structured at D14, D30 and D90, and surgery is considered only around day 10 if it is needed.
What Noria Health does not do: set a surgical indication on an image alone, or propose an isolated subacromial decompression for shoulder pain without a tear. A rapidly developing motor deficit, numbness in the saddle area, a recent change in bladder control, a hot and feverish joint or sudden loss of use after an impact are matters for the emergency services in your country, immediately, not for an appointment.
Who reviewed this page
Noria Health editorial team.
The musculoskeletal articles
- Spine: at 50, 80% of people with no pain have a degenerate disc
- Joint replacement: 82% of knees are still in place at 25 years
- Shoulder: 65% of rotator cuff tears do not hurt
- A spine MRI does not tell you the pain
- What waiting costs in orthopaedics
- Pain that waits
- Insoles, posture and what the trials measure
Have your case reviewed. Noria Health arranges a specialist consultation near Brussels and confirms feasibility within 24 to 48 hours. Open a case.