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If 99% of adults have an abnormality, it ceases to be abnormal regardless of its effects

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

This is well known for spine issues in general: MRI is super unspecific, and the older you get, the more interesting things you can find on the scans. Even if you're fully asymptomatic. So such findings are now better reframed as age-related changed rather than pathologies. The fact that every radiologist will highlight different things also doesn't help.

This is in fact one reason why you don't want an MRI if the outcome does not change what you do (i.e. sports related injuries or non specific low back pain). You will just nocebo yourself into thinking you have problems that are not real, because the belief in the answer donut is so strong.

That makes perfect sense to me.

One nit: this happened to me maybe 20 years ago. It wasn’t even an age-related change. I think it was more like a changing idea of the range of normal human anatomy.

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

Ok, in that case it's safe to say that the normal is highly variant but generally follows a pattern. People generally have a nose in the center of their face so that'd be normal, but one on the forehead would be abnormal unless everyone suddenly also had forehead noses

Relevant history from the US Airforce in the 1940s when they tried to build a cockpit for the average pilot and failed

I find this an interesting take on the story

https://polkas.github.io/posts/cursedim/

This is also a good argument why "opinionated" designs like from Apple are a bad idea. The average user does not exist. Stop trying to turn us into one!

I have used an iPhone for 8 years and a macbook for 2 years. Every year the experience gets worse, like on schedule. This theory might explain what is happening!

Same with Windows; that's why I switched to Linux.

That’s different. Deciding you’re building a tool for a specific use-case is not related to “average users”.

Tool companies manufacture claw hammers despite some people wanting a nail gun. You don’t try to make a thing flexible enough to be both a nail gun and a hammer.

I’m a power user and I do all of my customization on my Linux desktop/laptop. I use an iPhone specifically because it’s locked down and don’t want a keyboard that has gone through no code review stealing all of my banking credentials.

From the article, it seems like even if we only consider one dimension, there'd be ~70% of pilots that are uncomfortable. I'd have thought to at least cover 1 standard deviation, thus covering 68% of "average" pilots. But with 10 dimension it'd still only cover measly 2% of them. If we go to 2 std (95%), the 10-power would be ~60%. Quite small but seems acceptable if the initial target is only ~30% of pilots.

But of course this assume all variables are independent. Seems like we could actually push the tolerance much lower than this raw math would suggest.

I would hate to be one of the ~80 million people in the world who have identical faces

Except that one guy.

Everyone is abnormal compared to yourself.

Dude I know exactly who you're talking about, that guy without a unique face! Weird as hell that he's the only one...

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".

Not "MRI is not trustworthy" but "abnormalities are not harmful". ("Allude", by the way; to "elude" is to escape.)

oof, thanks for the grammar fix!

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.

There’s a famous case study in design about the Average Pilot - they were making airplanes than nobody could fly well because nobody was average enough in all physical dimensions to be comfortable in the aircraft. They had to design for ranges that the equipment could adjust through.

Even then when I was a kid I knew a guy who wanted to join the air force and he had a growth spurt that made him too tall.

More of the history of "avenge pilots" here: https://99percentinvisible.org/episode/on-average/

> Daniels realized that none of the pilots he measured was average on all ten dimensions. Not a single one. When he looked at just three dimensions, less than five percent were average. Daniels realized that by designing something for an average pilot, it was literally designed to fit nobody.

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.

Alcohol also reduces awareness of heart attacks.

https://theonion.com/report-aspirin-taken-daily-with-bottle-...

Your claim may or may not be true, but "The Onion" has been satire/joke news since 1988.

> alcohol is a blood thinner

Source?

Alcohol reduces clotting factors in the blood. This is known.

Doctors mostly tell you not to drink because it’ll fuck with the anesthesia math and bad anesthesia doses can kill you just as dead as a surgical mistake and probably moreso. But it’ll also make you bleed more.

If you need courage to show up to surgery they’ll give you a prescription for a single dose of a benzo. Which is better than liquid courage anyway.

A patient being drunk wouldn’t make it any harder for me to anaesthetise them. But if they’re drunk they wouldn’t legally be able to confirm they consent to the anaesthetic immediately prior.

Given the multiplicative effect of sedatives and depressants, do you have to factor in inebriation, for instance for a DUI in the ER? Or are the safety margins sufficient?

Generally additive, not multiplicative, and we are used to it. “Titrate to effect” is pretty standard in anesthesia, and we are watching you far more closely than average. Continuous monitoring of oxygenation, breathing, and cardiac rhythm, with no more than 5 minutes between blood pressure readings.

Can you not consent to have something done to you while drunk, while you're sober beforehand? I mean you can sign beforehand to have surgery performed while you're knocked out, that's a bit more inebriated than most sorts of drunk.

average ≠ normal

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

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Best thing a doctor ever told me was "you CAN get imaging done, but I'd like to warn you that there is a near-certainty we'd find something wrong with your shoulder and your back".

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

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Given that most commenters do not seem to have read the article perhaps the headline could be more explicit about 'MRIs find "abnormalities" but they seem to have no relationship to actual health problems"

Who's the freak without an abnormality?

https://en.wikipedia.org/wiki/Eye_of_the_Beholder_(The_Twili...

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

I would strongly bet against gym rats not having some shoulder abnormality. If anything, I'd expect them to have more issues with their tendons and ligaments.

I'd bet they probably have some abnormality too, but I don't think I'd expect them to have more issues. There's a lot talked about people getting injured in the gym, but people get injured a lot outside the gym, just for some reason people really fixate on in the gym injuries.

There's lots of research that indicates that frequent strength training significantly reduces your risk of injury in day to day activities, especially later in life. If I can deadlift 500 pounds, I'm not going to get injured lifting 100 pounds, but your general population could. If I've got 3 inches of muscle around my hips and increased bone density from resistance training, I'm not going to break my hip when I trip.

"Strong people are harder to kill" -Mark Rippetoe

Training reduces your risk of injury as long as you don't overtrain. Overtraining increases your risk of injury, but the injuries you sustain are training-related. For example you can really mess up your knees by running more than your body can handle or by running without warming up and stretching first. But the kind of injury you get is different from messing your knees up by falling over.

yeah. and joints, especially. I lost some wrist mobility during my boxing years and it never came back, even though I was in my early 20's when I had quit.

I mean, boxing is, by design, much more violent and higher impact than most other gym exercises.

Why didn’t you wrap up

wraps won't save your knuckles/wrists/elbows from the damage caused by repeated high-force impacts, and the cartilage only has to heal wrong once for a lifetime of mild discomfort.

More likely someone who's been in a coma for the last ten years.

They'd probably have to specifically focus on mobility and flexibility as well. You really need both of those in conjunction with enough strength.

Gymnasts are known to have very worn out shoulders which can be seen in scans. Eg at ~25yo they have shoulders of a ~40 to 50 year old person.

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

Steph Curry

He’s getting old, but not over 40 yet.

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

My labrum was torn from multiple shoulder dislocations. I don't think that began at my foot or hip.

Most of my shoulder issues are sleep related since I sleep on my side. Getting a body pillow system, was costly but kinda worth it. Helps with shoulder and GERD. Only issue is that it's kinda warm and I like to sleep cool.

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

You can try raising the head part of the bed by 5 - 6 or so inches using wood blocks. The doctor recommended it to me.

It's not perfect, but has really helped me!

Same here, it helped a lot. Also don't eat a big meal and go straight to bed. Aim for an earlier dinner.

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.

Wouldn’t the MRI decide if surgery would be beneficial?

So many other factors and physical therapy is required for insurance approval anyway.

> was costly but kinda worth it

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

Didn't they find something similar for herniated disc a while back? Meaning they were treating people for herniated discs with back pain and then eventually figured out that lots of people with no pain also had herniated discs?

I’m over 40. Barely. But, over 40 nonetheless.

I grew up in front of a PC as early as 6. I used it for everything. I grew up with it, on the internet as it was blossoming, and escaped through it as a means to escape reality, bullying, abusive household… you name it, from early Heat.net/mplay.net days, early mIRC CS alpha/beta/1.6 days, ICQ, MSN, VBasic coding, learning C/C++, to just about doing everything on a computer. Hell, I'm in the career I'm in because of it.

I escaped and escaped hard. If I couldn’t access it at home, I’d bike to the library and access it, or joined the computer club in HS just so I had another one I could easily hop on. All hours of the day, you name it. I even bumped into some wild early AOL Chat Room days that I'm pretty sure were some kind of a ring, but I digress.

I remember over the years comments like, “you look like you watch too much TV”. I barely watched TV. Or, “why are your shoulders always raised?”. I always said I'm carrying a heavy backpack with all my books. Or, “what’s wrong with your right neck?”, or “why are you corkscrewing to the left”. You name it. I just shrugged it off.

As the years went on, my jaw started to hurt, my right rotator cuff would crack all the time, my right ab snapped, my obliques weakened, my right hips started to fail, I don’t think I have a right scapula at this point, my molars no longer touched, my head jetted forward, my tongue tied, my lower jaw went to the left, my breathing worsened, it became shallow and short, my right-diaphragm hurts to inhale… I always blamed it on poor genetics, or something else, or "some accident I guess I don't remember".

It wasn’t until I hit 39 when it all kind of clicked.

It’s years of using a god damn mouse. Forward, right, back, left, circle motions, rinse and repeat, 12+ hours a day. In fact, even to this day I'm unable to use a mouse for more than 5 hours a day before the flares start. It's a numb pain. A 3/10 discomfort, but it's chronic.

I’m unable to sleep more than 4 hours a day without waking up with excruciating pain down my right shoulder and neck, unable to feel a large part of my right side, and the pain is getting worse by the day.

Ive done PT, chiro, acupuncture, personal trainer, you name it. THOUSANDS of dollars to no avail. In fact, I tried to do the 2000 pushup challenge for February (maybe a Canadian thing?) and I had to stop after 10 days due to INSANE right-shoulder flare-up.

Where’m I going with this?

Log off people. Stretch. Do exercise. Something before it’s too late.

I’m pretty sure we’re going to see more and more of “millennial” style abuse and neglect rear its ugly head.

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

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.

Thank you. I’m going to look into this! Any recommendations?

I’m currently on a split keyboard, and mouseless (mouseless.click) evironment at home. It affords me hours before the pain catches up.

The issue right now is work. 8 hours a day on archaic input devices, but if I can bring in a literal mouse replacement, then I’m in the clear!

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.

Closely related to a huge problem in American health care --- overprescription, particularly of surgical procedure. There's evidence that some widespread classes of surgical intervention --- shoulder "impingement" in particular --- have outcomes no better than placebos in controlled trials where people literally get placebo incisions.

Do they define if this relates to anything noticeable in your day to day?

For example, I can put my right hand above my shoulder and left hand near my lower back and easily connect both hands behind my back with fully interlocked fingers by converging in the middle. They reach to the other hand's palm.

But I can only barely touch my fingers with both hands if I switch it up so my left hand is up top.

I have no pain or day to day mobility issues but something is lopsided. Is that what they consider abnormal?

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 kids and they've messed up my dominant schoulder (left).

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?

Walking/carrying at all crazy hours once they were >30kg. Holding 40kg of sick kid around is fun. Ours all refused to sit in the stroller very early which is what made it so much worse (our oldest was two, the other two refused point blank the second they could walk).

not OP but - walking, carrying, holding, being pulled in random directions, catching kids when they jump at you from unexpected places, kids using your arms to practice tug-of-war/rock-climbing, pushing (empty) stroller with one hand, and carrying kid with other....

I don't know what causes it, but even without major issues I think a lot of people continually loose range of motion in the shoulder as they age. So this doesn't surprise me.

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.

I have a giant metal plate in mine which I guess is kindof abnormal.

Interesting. What happens at 40 to make MRIs no longer accurate?

Why do you think it's inaccurate?

related discussion here - https://news.ycombinator.com/item?id=47008607

What about the other 1%? I feel for them.

Just hit my mid twenties. Want to say I started having some shoulder issues around 20 years old. Although correlation =! causation, I largely think this is because of my lifelong computer usage and PC gaming. It doesn't bother me all the time, but every few months something will change up and it comes back. Surprisingly, my wrists and hands are completely fine, no carpal tunnel or anything similar.

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.

I think using a standing desk has really helped. I don't use mine at work often, but I generally am standing when I'm at home and it really does feel like it has improved my shoulder issues and posture.

Evolution never really bothered with the wellbeing of 40+ year olds.

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.

Evolution typically happens on the scale of a million years, not a couple generations of human behavior.

You can speed it up.

It's much the same with degenerative changes in the spine. Almost every adult will have such changes and they do not seem to correlate with symptoms. Everyone's back is screwed up and only some people get back pain, and only sometimes in the same areas as the screwed up areas.

> 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.

Reading this title made me sit up in my chair.

Even though they never have any neck pain, many shoulder issues are actually caused by pinched nerves in the cervical spine.

100% of all things that do not asexually reproduce are mutants

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You call it "abnormality", I call it evolution. We are not the same.

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

Im not sure people with bad posture get more offspring than others. :)

The pickins are getting slim though. I don't know anyone in their 20s that doesn't sit hunched over staring at a screen for a large portion of their day while stipulating I don't know any where near all 20 somethings. Just one person's observations

If I learned anything at Buy N Large University, AR screens in eyeware may be huge.