Help, I need a scan!

by Dan Atkinson

Thank you all for a fantastic response to our new website, we have had some positive feedback………even on the photos.

The point of today’s blog is on an important discussion we often have with patients, when is imaging appropriate?

The most common decisions come with an acute traumatic injury where there is potential for hard or soft tissue damage. For example, an injured ankle from a ‘rolling’ injury. In this scenario there are guidlines we can use to help our decision, the ‘Ottowa ankle rules’. These state areas of evidence that support a referral for an X-ray once you have a complete history of the mechanism of injury.

  1. Bone tenderness at the posterior edge or tip of the lateral malleolus
  2. Bone tenderness at the posterior edge or tip of the medial malleolus 


  1. The inability to weight bear both immediately and in A&E for 4 steps

The important component to remember in this case, and in all referrals for imaging, is you are ‘asking a specific question’ or ‘looking for a specific diagnoses’ and once done there will be a ‘specific change to your treatment’ in response to the result.

When is imaging not appropriate? When you don’t know what you are looking for! It is not helpful to send a patient from physiotherapy for a scan to ‘find out what’s going on’.  The reason we do not do this is because of the large variation in normal anatomy and the high volume of incidental findings seen on MRI and other forms of scan. This is particularly the case with lower back pain. If you were to scan the general population with and without back pain, just by looking at the scan, it would be extremely unreliable in determining which of the participants had back pain.

If you feel you require imaging for a musculo-skeletal injury, our advice is to seek physiotherapy first. A physiotherapist will be able to tell you if you require a scan and reason why that is the best course of action in your case.

Enjoy the bank holiday weekend and watch out for the storms!