On the one hand, that's the point of the article. That it ceases to be a useful diagnostic indicator.

On the other hand, if there are 100 places in the shoulder where you can have an abnormality, and most people have just one or a couple but the other 98-99 are normal, then each one individually really is abnormal.

So it's complicated, and then it becomes important to figure out which abnormalities are medically relevant, in which combinations, etc.

That's actually what the article points out. But I do think the language of normal vs abnormal obfuscates some of the intent. It's a 'deviation from healthy baseline' that they're talking about, and there are multiple such deviations in the grouped 'anomalies'.

From the article:

The language in particular should change given that “abnormalities” are ubiquitous—thus normal—and shouldn’t be described in terms that indicate a need for repair, like “tear.”

I went to a doctor for something unrelated and ended up getting an MRI that happened to show my upper spine. The neurologist read it and determined that I have a Chiari I malformation[0]. I have no symptoms from this whatsoever. I never have. It's unlikely that I ever will. If it weren't for the MRI, I'd never have known.

Doctors use to think that the degree of it that I have meant I'd have problems with it. After all, people who came in with the symptoms and then had an MRI or CT scan tended to show that level of herniation. Thus, it was assumed, that level of herniation was considered a diagnostic indicator. And then MRIs became cheaper and more accessible, and patients had them for all sorts of other reasons — like I did. Doctors discovered that the degree of "malformation" I have is very common among asymptomatic adults. In fact, you're many times more likely to be perfect fine with it than to experience symptoms.

Well, huh. That doesn't sound like much of a malformation anymore. Or at least, by itself it doesn't mean anything, other than that perhaps you're more likely to have problems than otherwise. On its own? It's more of a normal variation.

[0] https://en.wikipedia.org/wiki/Chiari_malformation

99% of adults have abnormal faces, they all look different!

Right, it's clearly aging related deterioration. It's like saying facial wrinkles are an abnormality.

I think the conclusion they're eluding to in the article is that: "if MRI says 99% of people have abnormalities, MRI is not trustworthy".

A majority of humans will eventually contract the herpes virus sooner or later and they will stay infected until they die. Does this make herpes normal? Maybe. Does this make herpes something we should stop worrying about? Probably not.

Yes in one sense, but it also points to the insufficency of "normalness". See also: The Average Soldier.

only if the abnormality is in the same spot

"1% of adults over 40 have abnormally normal shoulders"

But seriously, the article addressed that

> The authors argue that the findings suggest clinicians should rethink MRI findings, changing not just how they’re used, but also how they’re explained to patients. The language in particular should change given that “abnormalities” are ubiquitous—thus normal—and shouldn’t be described in terms that indicate a need for repair, like “tear.”

1% are suffering from a normality ;)

Abnominal (not abdominal)

If a town existed where 80% of the population had their arm become infected and fall off would you consider it normal ?

You're treating it like a behavior where normal is defined by the majority. Human anatomy and function is what you should compare to

no it doesn’t. not at all. “abnormality” is a measure vs. the median… what else could “abnormal” possibly even mean? how could anyone ever be abnormal in any way otherwise, given the number of possible avenues of abnormality in the universe? this logic can only even “play ball” with a singular “is this person abnormal or not?” boolean… if there existed even two axes of abnormality then by your folksy definition it cannot actually exist. QED.

If you ignore the time dimension, sure.

But if 99% of adults today have an abnormality that 99% of adults historically didn't, it's abnormal.

It's a poor term but it's talking about a healthy baseline for any human as far as I'm aware. It's not adjusted for expected deterioration due to age. 100% of organs eventually fail if given enough time, but it's still fine to call the resulting failed organ a defect.

Presumably, some of this is just it's pretty damn inevitable you're going to accumulate at least some level of detectable injury that doesn't completely heal over the course of 40 years. I needed shoulder reconstruction because I fell off a skateboard trying to bomb a hill a year and a half ago and it's healed to the point there isn't any functional impairment, but given there's metal in there now, it's obviously going to look abnormal on an image. There's just an impedance mismatch here between what imaging finds and what people actually care about. Any detectable deviation from expected tissue configuration is going to show up and get reported, but there is no reason for a patient to give a shit. Functional impairment and/or pain is what they care about, though those are both also universal if you live long enough. No 90 year-old walks without a limp but it's still completely fair to call a limp an "abnormal" gait.

Not if they are all different and produce negative effects

Dunno man. When enough people overweight, 1-2 alcoholic drink become healthy (alcohol is a blood thinner): this happened, but as we know now it's not true.

average ≠ normal

if they all have the same abnormality yeah but if they all have different abnormalities then they're still abnormalities.

[dead]

got a similar advice ... "in your age we find almost every time something abnormal"

Im guessing certain gym rats who also dont desk/computer work?

Oh hey it's me, I'm the conformist. Stop picking on me.

Steph Curry

A statistical error. All humans are slightly asymmetrical. Most shoulder problems begin at foot and/or hip though.

Any recommendations? I have GERD and generally sleep on my back, which helps but isn't perfect.

The issue with those inclined pillows with the arm hole in them is that they can be a really hard angle for a side sleeper to be at. It makes my back and hips hurt way worse than my shoulder.

i recommend a bedjet. got it for the wife and it’s rough to sleep without it now.

Cervical radiculopathy can cause shoulder pain. I have experienced this quite a bit and it's probably also because of my sleeping style. I wouldn't get an MRI unless I was planning to have surgery.

> was costly but kinda worth it

This doesn't inspire confidence, but I guess any improvement that mitigates pain is nice.

Some years ago, I also started to have problems due to mouse use.

I experimented with alternative pointing devices. For a few years I have used trackballs. The change from mouse to trackball was good, but that still was not an optimum pointing device.

Eventually I have settled on replacing mice with small graphic tablets (Wacom Intuos S), configured in the "Relative" mode, instead of their default "Absolute" mode. The tablet is not bigger than a traditional mouse pad, so it does not take more space on the desk.

In this mode the tablets behave exactly like mice, but they are much more comfortable and also faster and more accurate. The comfort is due to the fact that you hold the extremely light stylus in a natural hand position and moving it to reach any point on the screen is instantaneous and effortless (even when only the fingers are used, without moving the hand). Moreover, touching the tablet instead of left click is also a more natural motion. The stylus is so light that I can also touch-type while keeping it between fingers, which speeds up the transitions between keyboard and pointing device, in comparison with a mouse that must be grabbed first.

Thus all my hand and arm problems have disappeared, regardless how many hours per day I use the pointing device.

Just stating the obvious that there's an entire culture around replacing mice by keyboards, starting with a Vim mode in most apps.

I think there's another dimension to this, which is the toxic home life which led to these behaviors. Good luck unpacking this all and getting healthier.

Limited range of motion on one side could cause some deviations in scapulohumeral rhythm, so your force application won't be optimal and may cause injuries, or even cause uneveness and side effects in gait cycle. And with time it tends to get worse since the body would be trying to adopt to execute the function. But suboptimal force application eventually would cause joint injuries if a convex (humerus) is rolling without gliding or vice versa or doing it in suboptimal rhythm.

That's my personal take, not a doctor, study kinesiology as a hobby.

All such minor mobility issues could be addressed by body conditioning excercises including simple isolated mobility drills to learn range of motion of joints.

I'd consider it abnormal that you can do that; I can't get my fingertips within a foot of each other doing that.

I'm nearly 60 but I don't know if I could ever do that. You have good mobility IMO.

I have three dogs and they’ve messed up my dominant shoulder, back and leg

From walking around holding them with your left arm when they were babies, or from something else?

Most people don't exercise to preserve muscle mass and function and especially don't do full range of motion resistance training, most of this is probably preventable.

Why do you think it's inaccurate?

Yes, sitting slightly hunched up with your hands in front of you on a keyboard for 8-10 hours a day will screw up your shoulder mobility over time.

Oddly enough, I think now it will. Because there is a whole generation of people having kids later, some first time parents even in their 40s. Naturally this should mean they produce offspring that over time is also able to easily reproduce in their 40s. Teen pregnancy is way down, and late pregnancies are replacing it.

> Everyone's back is screwed up

its bad framing to label this as "degenerative" and "screwed up" as nowadays we learn that there are probably more age-related. As you say, they correlate very poorly with pain.

How many generations of constant bent over posture staring at a device before that's just built into the species?