Dr Angela Cadogan
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In Defence of Imaging: When Less Isn't More

29/10/2025

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Introduction: Don't Blame the Scan
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In recent years, a growing number of academic papers and social media narratives have raised concerns about rising imaging rates in musculoskeletal (MSK) care. The argument is familiar: imaging doesn’t help, causes harm, and fuels overmedicalisation by assigning labels that instill fear or lead to unnecessary interventions. (1, 2) 

Adding to the argument are studies showing that “abnormal” imaging findings such as disc degeneration or rotator cuff tears, are frequently present in people without symptoms. These findings are often used to recommend avoiding imaging in symptomatic individuals and to argue that similar findings in those with pain are often incidental or irrelevant.  (3-7) Some also claim that routine imaging fails to improve outcomes like pain, function, or satisfaction.(8) Taken together, these messages have driven a narrative that imaging is overused, harmful, and clinically invalid and should therefore be broadly avoided.(4)

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Is X-Ray Needed in the Diagnosis of Frozen Shoulder?

25/6/2022

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Dr Angela Cadogan, PhD, NZRPS

Frozen shoulder is still poorly understood on many levels. However the diagnostic criteria for have remained unchallenged for decades: Frozen shoulder is a clinical diagnosis characterised by:
  1. a global loss of passive ROM
  2. a ‘normal’ x-ray (to exclude other causes of joint stiffness).

In my career, I have seen people diagnosed and treated for frozen shoulder for more than 2-3 years with a ‘wait and see’ approach, or with multiple injections without an x-ray to exclude other causes of stiffness.  Some of these people were subsequently diagnosed with osteoarthritis, avascular necrosis, and (one) posterior dislocation.  Other causes of shoulder pain and stiffness include primary or secondary bone tumour, traumatic, osteoporotic or pathologic fracture and muscle guarding.

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    Dr Angela Cadogan

    Passionate about shoulders and helping others to think critically about their practice. I hope these posts stimulate your thinking.

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  • Home
  • About
  • Clinical
    • Outcome Questionnaires
    • Clinical Guidelines
  • Research
  • Education
    • Courses >
      • Shoulder Academy
      • Online Courses
      • Practical Courses
    • Inservice Education
    • eBooks
  • Leadership
    • Mentoring
  • Blog