Guidelines for the use of diagnostic imaging in musculoskeletal pain conditions affecting the lower back, knee, and shoulder: A scoping review

Key Points

1. The routine use of diagnostic imaging for those with non-traumatic low back pain, knee or shoulder pain is discouraged in primary and intermediate care.

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BACKGROUND & OBJECTIVE

Musculoskeletal (MSK) pain is one of the most common reasons for primary care consultation, with the most common body sites being the lower back, knee, and shoulder. The use of diagnostic imaging for MSK pain is increasing, but it is unclear whether this increase is justified on the basis of clinical practice guideline (CPG) recommendations.

For those presenting with non-traumatic MSK pain, the recommended first line clinical care is non-surgical (1) and includes advice and education, exercise, and activity modification. Despite this, the use of diagnostic imaging (DI) for MSK pain is increasing, particularly in primary and intermediate care. It is unclear whether this increase is justified on the basis of clinical practice guideline (CPG) recommendations.

The objective of this review was to determine whether recommendations for DI within CPGs justify the increasing use of DI within UK primary and intermediate care, for non-traumatic lower back, knee, and shoulder pain.

The use of diagnostic imaging for musculoskeletal pain is increasing.

When someone is not responding to initial management this does not default to a recommendation to utilize imaging, as there may be other factors that explain the lack of progress seen.

METHODS

A scoping review of CPGs that influence clinical practice in the United Kingdom (UK) was performed. A scoping review seeks to map and identify key factors related to the concept of interest and identify any knowledge gaps (2). A comprehensive

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