Rotator Cuff Tear X-Ray: What to Know & Limitations

An X-ray, although a common first-line diagnostic tool, offers limited direct visualization of the rotator cuff itself due to the soft tissue composition of structures such as the supraspinatus tendon. Orthopedic surgeons often use X-ray imaging to initially assess patients presenting with shoulder pain, primarily to rule out other potential causes such as fractures or osteoarthritis, conditions frequently evaluated at institutions like the Mayo Clinic. While a standard rotator cuff tear X-ray cannot directly reveal the tear, it can show secondary signs like a high-riding humerus, indicating the possible presence of a tear, thus guiding further investigation with MRI.

X-Rays and the Rotator Cuff: Unveiling the Diagnostic Puzzle

Shoulder pain is a pervasive issue, impacting a significant portion of the general population. It can stem from a variety of sources, making accurate diagnosis a critical first step toward effective management. The rotator cuff, a group of muscles and tendons surrounding the shoulder joint, plays a vital role in shoulder function.

The Rotator Cuff's Critical Role

The rotator cuff is essential for shoulder stability, range of motion, and overall functionality. Injuries to the rotator cuff, such as tears, are unfortunately common, leading to pain, weakness, and limitations in daily activities. Understanding the intricacies of the diagnostic process is paramount for navigating these challenges and ensuring appropriate treatment.

Diagnostic Imaging and its Importance

When shoulder pain arises, diagnostic imaging often becomes a crucial tool in identifying the underlying cause. X-rays are frequently among the first imaging modalities employed. While X-rays are valuable for assessing bone structures, their role in visualizing soft tissues, like the rotator cuff, is limited.

The Diagnostic Puzzle: X-Ray's Role

This discussion explores the utility and, more importantly, the limitations of X-rays in diagnosing rotator cuff tears. We aim to clarify what X-rays can reveal about the shoulder joint in the context of a potential rotator cuff injury. Additionally, we'll address the reasons why they often fall short in directly visualizing these soft tissue structures. Finally, the role of alternative diagnostic tools to ensure a more comprehensive evaluation will be assessed.

Rotator Cuff Anatomy and Function: A Foundation for Understanding Injuries

The shoulder joint, a marvel of biological engineering, allows for an exceptional range of motion. This very flexibility, however, makes it inherently susceptible to injury. To understand the nuances of rotator cuff tears and the diagnostic approaches used to identify them, a firm grasp of the shoulder's anatomy and biomechanics is essential.

The Shoulder Joint: A Symphony of Movement and Stability

The shoulder joint, technically known as the glenohumeral joint, is a ball-and-socket joint formed by the head of the humerus (upper arm bone) and the glenoid fossa of the scapula (shoulder blade). Unlike the hip joint, where the socket is deep and provides inherent stability, the glenoid fossa is relatively shallow. This design prioritizes mobility over stability.

The stability of the shoulder joint is therefore heavily reliant on the surrounding soft tissues, including the ligaments, the labrum (a fibrocartilaginous rim that deepens the glenoid fossa), and, most importantly, the rotator cuff muscles.

The complex biomechanics of the shoulder involve intricate coordination between these structures, allowing for a wide array of movements, including flexion, extension, abduction, adduction, internal rotation, and external rotation.

The Rotator Cuff Muscles: Anatomical Breakdown

The rotator cuff is comprised of four muscles that originate on the scapula and attach to the humerus via tendons. These muscles work synergistically to control the movement of the shoulder joint, stabilize the humeral head within the glenoid fossa, and enable a wide range of arm movements. A detailed look at each muscle follows:

Supraspinatus: Abduction and Beyond

The supraspinatus muscle, located on the upper back of the scapula, is primarily responsible for initiating abduction of the arm (lifting the arm away from the body). It is the most commonly injured rotator cuff muscle, often due to impingement under the acromion (the bony projection of the scapula that forms the "point" of the shoulder).

Repetitive overhead activities, such as throwing or painting, can contribute to supraspinatus tendinopathy (inflammation of the tendon) and eventual tearing.

Infraspinatus: External Rotation Powerhouse

The infraspinatus muscle, located below the supraspinatus on the back of the scapula, is a primary external rotator of the shoulder. It helps to slow down internal rotation, playing a crucial role in activities such as throwing a ball or reaching behind your back.

Infraspinatus tears often occur in conjunction with supraspinatus tears, reflecting the synergistic function of these muscles.

Teres Minor: External Rotation and Stability Assistant

The teres minor, a smaller muscle located below the infraspinatus, also contributes to external rotation of the shoulder. It assists the infraspinatus in controlling external rotation and contributes to the overall stability of the shoulder joint.

Due to its smaller size and location, the teres minor is less frequently involved in rotator cuff tears compared to the supraspinatus and infraspinatus.

Subscapularis: The Internal Rotation Expert

The subscapularis muscle is located on the anterior (front) surface of the scapula and is the only rotator cuff muscle that internally rotates the shoulder. It plays a crucial role in activities such as reaching across the body or throwing a punch.

Subscapularis tears are less common than supraspinatus tears but can occur due to trauma or repetitive stress. Given its anterior location, it also contributes to anterior shoulder stability.

Rotator Cuff: The Cornerstone of Shoulder Function

The rotator cuff's role extends far beyond simple muscle action. The coordinated action of these four muscles is essential for maintaining shoulder stability. They compress the humeral head into the glenoid fossa, preventing excessive translation and dislocation. They also provide a dynamic control mechanism to modulate movements.

Without the stabilizing action of the rotator cuff, the larger muscles around the shoulder, such as the deltoid, would cause the humeral head to migrate superiorly (upward), leading to impingement and pain. The rotator cuff allows for smooth, controlled, and pain-free movement throughout the shoulder's full range of motion.

Decoding Rotator Cuff Tears: Causes, Symptoms, and Diagnostic Importance

The intricate workings of the rotator cuff are often taken for granted until pain and dysfunction disrupt daily life. Understanding the factors that lead to rotator cuff tears, recognizing their characteristic symptoms, and appreciating the critical role of accurate diagnosis are paramount for effective management and optimal patient outcomes.

Unraveling the Etiology: Causes and Risk Factors

Rotator cuff tears are rarely the result of a single event; rather, they often stem from a combination of intrinsic and extrinsic factors accumulating over time. Understanding these predisposing elements is crucial for both prevention and targeted treatment strategies.

• Age-Related Degeneration: The most prevalent cause is gradual, age-related degeneration of the tendon tissue. As we age, tendons naturally lose elasticity and blood supply, making them more susceptible to injury. This process, known as tendinopathy, weakens the rotator cuff over time.

• Repetitive Overhead Activities: Certain occupations and sports involving repetitive overhead motions place undue stress on the rotator cuff. Painters, carpenters, tennis players, and baseball pitchers are at increased risk. These activities cause microtrauma to the tendons, leading to inflammation and eventual tearing.

• Acute Injury: A sudden, traumatic injury, such as a fall onto an outstretched arm or a direct blow to the shoulder, can cause an acute rotator cuff tear. These types of tears often occur in younger, more active individuals.

• Bone Spurs (Subacromial Impingement): The presence of bone spurs (osteophytes) on the acromion can narrow the space available for the rotator cuff tendons. This impingement can cause friction and irritation, leading to tendon damage and tears over time.

• Poor Posture and Biomechanics: Poor posture and improper body mechanics can alter shoulder joint alignment and increase stress on the rotator cuff. Addressing these biomechanical imbalances is important in both preventing and treating rotator cuff tears.

• Genetics: Emerging research suggests a possible genetic predisposition to rotator cuff tears. Individuals with a family history of rotator cuff problems may be at higher risk.

Recognizing the Warning Signs: Common Symptoms

The symptoms of a rotator cuff tear can vary depending on the severity and location of the tear, as well as the individual's activity level and pain tolerance. However, several common symptoms are frequently reported.

• Shoulder Pain: Pain is the most common symptom of a rotator cuff tear. The pain is often described as a deep ache or throbbing sensation in the shoulder.

  The pain may radiate down the arm or into the neck. It is typically worse with overhead activities, reaching behind the back, or lying on the affected side.

• Weakness: Weakness in the shoulder and arm is another characteristic symptom. It may be difficult to lift or rotate the arm, especially against resistance.

  Weakness can interfere with daily activities such as dressing, combing hair, or carrying groceries.

• Limited Range of Motion: Rotator cuff tears can restrict the shoulder's range of motion. Individuals may have difficulty reaching overhead, behind their back, or across their body.

  Stiffness and a feeling of "catching" or "grinding" in the shoulder joint may also be present.

• Night Pain: Many individuals with rotator cuff tears experience increased pain at night, particularly when lying on the affected side.

  This nocturnal pain can disrupt sleep and significantly impact quality of life.

• Clicking or Popping: Some people may hear or feel a clicking or popping sensation in the shoulder joint when moving their arm.

  While not always present, this symptom can be indicative of a rotator cuff tear or other shoulder pathology.

The Diagnostic Imperative: Charting the Course for Effective Treatment

Accurate diagnosis is the cornerstone of successful rotator cuff tear management. A precise diagnosis not only confirms the presence of a tear but also identifies its size, location, and chronicity, all of which are crucial for determining the most appropriate treatment plan.

• Guiding Treatment Decisions: The size and location of the tear, as well as the patient's activity level and overall health, will influence whether conservative management or surgical intervention is recommended.

  An accurate diagnosis ensures that patients receive the most effective and tailored treatment approach.

• Optimizing Rehabilitation: A clear understanding of the tear characteristics allows for the development of a targeted rehabilitation program. Physical therapy protocols can be customized to address specific muscle imbalances and range-of-motion deficits.

  This precision leads to better functional outcomes and faster recovery.

• Avoiding Unnecessary Interventions: Accurate diagnosis helps to rule out other potential causes of shoulder pain. This minimizes the risk of unnecessary or inappropriate treatments, such as surgery for a condition that could be managed conservatively.

• Improving Patient Outcomes: Ultimately, accurate diagnosis leads to improved patient outcomes. By receiving the right treatment at the right time, individuals with rotator cuff tears can experience pain relief, restored function, and a return to their desired activities.

X-Rays and Rotator Cuff Tears: What You Can (and Can't) See

While advanced imaging techniques like MRI and ultrasound often take center stage in diagnosing rotator cuff tears, the humble X-ray still plays a valuable, albeit limited, role.

Understanding the capabilities and shortcomings of X-rays is crucial for both clinicians and patients navigating the diagnostic process. Let's delve into what X-rays can and cannot reveal when evaluating a potential rotator cuff injury.

The Fundamentals of Radiography

X-rays, or radiographs, use electromagnetic radiation to create images of the body's internal structures. Dense tissues, like bone, absorb more radiation and appear white on the image.

Less dense tissues, like muscles and tendons, allow more radiation to pass through, resulting in darker shades. This fundamental principle explains why X-rays are excellent for visualizing bony structures but less effective for soft tissues.

Direct vs. Indirect Visualization: The Rotator Cuff Dilemma

X-rays cannot directly visualize the rotator cuff muscles or tendons. These soft tissues are largely transparent to X-rays, rendering them invisible on standard radiographs.

This is a critical limitation. A rotator cuff tear, which involves damage to these very tissues, will not be directly seen on an X-ray.

However, X-rays can reveal indirect signs suggestive of a rotator cuff tear. These signs involve changes in the surrounding bony structures that may occur as a consequence of the tear.

Unveiling the Indirect Clues: What X-Rays Can Show

While X-rays cannot directly image a rotator cuff tear, they can provide valuable clues about its presence and severity.

Bone Spur Formation (Osteophytes)

One of the most common indirect signs is the presence of bone spurs, also known as osteophytes, around the shoulder joint. These bony outgrowths often develop in response to chronic inflammation and instability caused by a rotator cuff tear.

Specifically, subacromial spurs, located on the underside of the acromion (part of the shoulder blade), can impinge on the rotator cuff tendons, contributing to the tear or exacerbating existing damage. The presence of significant spurring is a strong indicator of underlying rotator cuff pathology.

Humeral Head Positioning

A long-standing rotator cuff tear can disrupt the normal biomechanics of the shoulder joint, leading to subtle changes in the position of the humerus (upper arm bone) within the glenoid fossa (shoulder socket).

For example, the humerus may migrate superiorly (upward) due to the loss of the rotator cuff's stabilizing effect. While these changes may be subtle, an experienced radiologist can identify them as potential indicators of a tear.

Evidence of Shoulder Arthritis

Chronic rotator cuff tears can contribute to the development of osteoarthritis in the shoulder joint. X-rays can readily detect signs of arthritis, such as joint space narrowing, bone-on-bone contact, and the formation of more prominent osteophytes.

The presence of significant arthritic changes may influence treatment decisions, as it can impact the success of rotator cuff repair surgery.

The Pitfalls of False Negatives

It's crucial to recognize that a normal X-ray does not rule out a rotator cuff tear. Many individuals with significant tears will have X-rays that appear unremarkable.

This is because the early stages of a tear, or smaller tears that do not yet cause significant bony changes, may not be detectable on X-ray. The possibility of a false negative result highlights the need for further investigation with more sensitive imaging modalities, such as MRI or ultrasound, when a rotator cuff tear is suspected despite normal X-ray findings.

Ruling Out Other Culprits: The X-Ray's Role in Differential Diagnosis

Despite their limitations in directly visualizing rotator cuff tears, X-rays are valuable for ruling out other potential causes of shoulder pain.

Identifying Fractures

X-rays are excellent for detecting fractures of the humerus or scapula (shoulder blade). A fracture can mimic the symptoms of a rotator cuff tear.

Therefore, obtaining an X-ray is essential to exclude this possibility, especially in cases of acute shoulder trauma.

Assessing Acromioclavicular (AC) Joint Arthritis

The acromioclavicular (AC) joint, located where the clavicle (collarbone) meets the acromion, is another common source of shoulder pain. X-rays can clearly visualize the AC joint and detect signs of arthritis, such as joint space narrowing and osteophyte formation.

AC joint arthritis can cause pain that is similar to that of a rotator cuff tear, so excluding this condition is an important part of the diagnostic process.

In conclusion, while X-rays cannot directly visualize rotator cuff tears, they provide valuable information about the shoulder joint and can help rule out other potential causes of shoulder pain. Understanding the limitations of X-rays and the importance of considering indirect signs is essential for accurate diagnosis and appropriate management of rotator cuff injuries.

Beyond X-Rays: Alternative Diagnostic Tools for Rotator Cuff Injuries

While X-rays offer a foundational glimpse into the shoulder joint, their inability to directly visualize soft tissues necessitates the use of alternative diagnostic tools when a rotator cuff tear is suspected. These modalities provide a more detailed and comprehensive assessment, guiding treatment decisions and ultimately improving patient outcomes.

Magnetic Resonance Imaging (MRI): The Gold Standard for Soft Tissue Visualization

MRI stands as the gold standard for imaging soft tissues, including the rotator cuff muscles and tendons. Unlike X-rays, MRI utilizes powerful magnetic fields and radio waves to create detailed images of internal structures.

This technology allows for the direct visualization of rotator cuff tears, revealing their size, location, and severity. MRI can also identify other associated pathologies, such as tendinosis (degeneration of the tendon), bursitis (inflammation of the bursa), and muscle atrophy.

The superior soft tissue contrast offered by MRI makes it invaluable in differentiating between partial-thickness and full-thickness tears, as well as assessing the quality of the surrounding tissues. This information is crucial for surgical planning and predicting postoperative outcomes.

Ultrasound: A Dynamic and Accessible Imaging Option

Ultrasound provides another valuable tool for evaluating rotator cuff injuries. It uses high-frequency sound waves to create real-time images of the shoulder joint.

One of the primary advantages of ultrasound is its dynamic assessment capabilities. Unlike static imaging techniques like X-rays and MRI, ultrasound allows for the real-time evaluation of the shoulder joint during movement.

This is particularly useful for identifying impingement syndromes and assessing the stability of the rotator cuff tendons during specific maneuvers. Ultrasound is also relatively inexpensive and readily accessible, making it a convenient option for initial screening and follow-up assessments.

However, ultrasound has limitations. The image quality is highly operator-dependent, requiring a skilled sonographer to obtain accurate and reliable results. Additionally, ultrasound may not be as sensitive as MRI in detecting small or partial-thickness tears. It can also be limited by body habitus, with image quality decreasing in patients with larger body mass indexes.

The accessibility and real-time capabilities of ultrasound make it a useful complement to MRI, particularly in experienced hands.

Arthrogram: Enhancing X-Ray Imaging with Contrast

An arthrogram involves injecting a contrast dye into the shoulder joint, followed by X-ray imaging. The contrast dye helps to outline the joint structures, making it easier to identify abnormalities.

While arthrography is less commonly used than MRI or ultrasound for diagnosing rotator cuff tears, it can be helpful in certain situations. For example, it may be used when MRI is contraindicated (e.g., in patients with certain metallic implants) or unavailable.

It can also be used to assess the presence of adhesive capsulitis ("frozen shoulder") or to evaluate the integrity of the glenoid labrum. When combined with MRI (MR arthrogram), the diagnostic accuracy for labral tears and subtle rotator cuff pathology increases.

The Indispensable Physical Examination

Imaging modalities are crucial, but a thorough physical examination remains an indispensable part of the diagnostic process. A skilled clinician can often identify rotator cuff tears based on specific findings during the examination.

This includes assessing range of motion, strength, and pain provocation. Specific provocative tests, such as the Neer impingement test, Hawkins-Kennedy test, and empty can test, can help to isolate and assess the integrity of the individual rotator cuff muscles.

These tests, when performed correctly, can provide valuable clues about the presence and location of a tear. The findings from the physical examination should always be correlated with imaging results to arrive at an accurate diagnosis.

The Importance of a Detailed Medical History

Finally, gathering a detailed medical history is essential for understanding the patient's symptoms, injury mechanism, and past treatments. This information can provide valuable context for interpreting imaging results and guiding treatment decisions.

For example, a history of acute trauma may suggest a different type of rotator cuff tear than one that develops gradually over time. Similarly, information about previous shoulder injuries or surgeries can help to identify potential risk factors and complications.

By integrating the information obtained from the medical history, physical examination, and imaging studies, clinicians can develop a comprehensive understanding of the patient's condition and create an individualized treatment plan. The medical history can also help with differential diagnoses that should be considered.

In conclusion, while X-rays play a role in the initial assessment of shoulder pain, alternative diagnostic tools such as MRI, ultrasound, arthrography, a thorough physical examination, and a detailed medical history are essential for accurately diagnosing and managing rotator cuff injuries. A comprehensive approach that integrates these modalities ensures optimal patient care and improved outcomes.

Navigating the Diagnostic Process: From Initial Assessment to Specialist Referral

The journey to diagnosing a rotator cuff tear is rarely a straight line. It's a process that often begins with a visit to a primary care physician and may culminate in consultation with a specialist, guided by imaging interpretations and a careful consideration of the patient’s overall presentation. Understanding this pathway is crucial for both patients and healthcare providers alike.

The General Practitioner's Role: Initial Evaluation

The initial assessment typically begins with a family doctor or general practitioner. The physician will take a detailed medical history, inquiring about the onset, duration, and nature of shoulder pain, as well as any relevant past injuries or medical conditions.

A thorough physical examination is then conducted, assessing the range of motion, strength, and stability of the shoulder joint. Specific orthopedic tests are performed to evaluate the integrity of the rotator cuff muscles.

Based on these findings, the primary care physician may order initial imaging studies, such as X-rays, to rule out other potential causes of shoulder pain, like fractures or arthritis. While X-rays cannot directly visualize the rotator cuff, they can provide valuable information about the bony structures of the shoulder.

When to Refer: The Specialist's Expertise

Referral to a specialist, such as an orthopedic surgeon or sports medicine physician, is often necessary when the initial assessment suggests a rotator cuff tear. Reasons for referral include persistent pain despite conservative treatment, significant weakness or loss of function, or findings on physical examination that strongly suggest a tear.

Specialists possess the expertise and advanced diagnostic tools needed to accurately diagnose and manage rotator cuff injuries. They can perform more specialized physical examinations and order advanced imaging studies like MRI or ultrasound to directly visualize the rotator cuff.

The specialist's evaluation will lead to a definitive diagnosis and the development of a tailored treatment plan.

Radiologists: The Interpreters of Images

Radiologists play a critical role in the diagnostic process. They are physicians who specialize in interpreting medical images, including X-rays, MRI scans, and ultrasound images.

Radiologists carefully analyze these images to identify any abnormalities, such as rotator cuff tears, tendinosis, or other associated pathologies. They provide a detailed report to the referring physician, outlining their findings and offering diagnostic impressions.

It's important to remember that a radiologist's report is just one piece of the puzzle. The referring physician must integrate the imaging findings with the patient's clinical presentation to arrive at an accurate diagnosis.

The Diagnostic Triad: Integrating Information

Accurate diagnosis hinges on integrating imaging results, physical examination findings, and the patient's medical history. No single element should be considered in isolation.

A positive finding on an MRI, for example, must be correlated with the patient's symptoms and the findings from the physical examination. A patient may have evidence of a rotator cuff tear on imaging but be asymptomatic.

Conversely, a patient with significant shoulder pain and weakness may have a normal MRI. This information should then guide treatment recommendations.

Sensitivity and Specificity: Understanding Test Accuracy

Understanding the concepts of sensitivity and specificity is important when interpreting diagnostic test results. Sensitivity refers to the ability of a test to correctly identify individuals who do have the condition (rotator cuff tear). A highly sensitive test will have few false negative results.

Specificity, on the other hand, refers to the ability of a test to correctly identify individuals who do not have the condition. A highly specific test will have few false positive results.

No diagnostic test is perfect. It is crucial to consider the sensitivity and specificity of each test when interpreting results and making clinical decisions. For example, MRI is considered a highly sensitive and specific test for diagnosing rotator cuff tears.

Treatment Options Based on Diagnosis: A Spectrum of Approaches

The diagnosis of a rotator cuff tear sets the stage for a crucial decision-making process: determining the most appropriate course of treatment. A spectrum of approaches exists, ranging from conservative management to surgical intervention, and the chosen path must be carefully tailored to the individual patient's specific circumstances, tear characteristics, and functional goals. Understanding the nuances of each option is paramount for both patients and clinicians.

Conservative Management: Prioritizing Non-Operative Strategies

For many individuals, particularly those with partial tears or those for whom surgery poses significant risks, conservative management serves as the initial treatment strategy. This approach focuses on alleviating pain, restoring function, and preventing further injury progression.

Physical Therapy: Restoring Function and Stability

Physical therapy is a cornerstone of conservative management. A tailored exercise program aims to:

• Restore range of motion.
• Strengthen the surrounding muscles to compensate for the torn rotator cuff.
• Improve shoulder stability.
• Enhance overall function.

Therapists employ a variety of techniques, including manual therapy, stretching exercises, and progressive strengthening exercises, to address individual patient needs.

Pain Management: Medications and Injections

Pain management plays a crucial role in enabling patients to participate effectively in physical therapy and resume daily activities.

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to reduce pain and inflammation.

In some cases, corticosteroid injections may be considered to provide more targeted pain relief, although their long-term effects on rotator cuff healing remain a subject of ongoing research.

Surgical Intervention: When is it Necessary?

When conservative measures fail to provide adequate pain relief and functional improvement, or in cases of acute, complete rotator cuff tears, surgical intervention may be warranted.

Indications for Surgical Repair

Several factors influence the decision to proceed with surgery:

• Severity of the tear: Complete tears often benefit more from surgical repair than partial tears.
• Patient activity level: Younger, more active individuals may be more likely to opt for surgery to restore full function.
• Persistent pain and functional limitations: If conservative treatment fails to alleviate symptoms, surgery may be considered.
• Impact on daily activities: If the tear significantly interferes with work, sports, or other essential activities, surgery may be a viable option.

Types of Surgical Procedures

Various surgical techniques are available for repairing rotator cuff tears, each with its own advantages and disadvantages.

• Arthroscopic Repair: This minimally invasive technique involves using a small camera and specialized instruments to repair the tear through small incisions. It typically results in less pain, faster recovery, and reduced risk of complications compared to open surgery.

• Open Repair: In some cases, an open surgical approach may be necessary, particularly for large or complex tears. This involves making a larger incision to directly access and repair the rotator cuff.

• Mini-Open Repair: This technique combines the benefits of both arthroscopic and open surgery, using a smaller incision than traditional open repair while still allowing for direct visualization of the rotator cuff.

The choice of surgical technique depends on the size, location, and chronicity of the tear, as well as the surgeon's experience and preference.

Regardless of the chosen approach, post-operative rehabilitation is crucial for optimizing outcomes and restoring full shoulder function. This typically involves a structured physical therapy program that gradually progresses from gentle range-of-motion exercises to more demanding strengthening exercises.

So, while a rotator cuff tear X-ray might not be the star of the show when diagnosing a tear, it can still offer valuable clues. Remember to chat with your doctor about the best imaging options for you – they'll help you figure out the right path toward feeling better!