MRI Findings Do Not Always Match the Suspected Source of Neck and Arm Pain

A 2022 study examined 83 patients with neck pain and related arm pain, comparing the nerve root identified through clinical examination with the most affected nerve root on cervical MRI.

The examination and MRI identified the same side and nerve-root level in only 31% of patients. Another 28% had agreement at a neighboring level. Clinical examiners also agreed with each other in only 58% of cases, illustrating the difficulty of pinpointing the responsible nerve root. PubMed

These findings do not mean MRI is only 31% accurate. The study measured agreement between clinical assessment and imaging; it did not independently establish which finding represented the true pain source.

The practical message is that an MRI abnormality should be interpreted alongside symptoms, strength, sensation, and reflexes. A scan can reveal a structural problem without establishing that it explains the patient’s pain. Disagreement calls for reassessment before selecting a treatment target. PubMed

Reference: Redebrandt HN, Brandt C, Hawran S, Bendix T. Clinical evaluation versus magnetic resonance imaging findings in patients with radicular arm pain—A pragmatic study. Health Science Reports. 2022;5(3):e589.