FIMAGE

Why is this study needed?

The origin of degenerative musculoskeletal pain has been traditionally attributed to structural alterations within the joints and surrounding structures. Today, these ”abnormalities” are sought by certain clinical manoeuvres and imaging. If symptoms persist, surgery is often recommended to patients to ‘restore deranged anatomy’. With increasing evidence that structural changes are common in asymptomatic individuals in various body parts, and their prevalence increases with age, the justification for surgery in degenerative musculoskeletal conditions can be questioned.

The root cause for degenerative shoulder pain remains unclear. Although both shoulder pain and MRI imaging abnormalities are common in the general population, it is still unclear to which extent they are interrelated and to which they are simply incidental

What are the objectives of the FIMAGE study?

The specific aims of the FIMAGE study are four-fold:

• First, to assess the PREVALENCE of anatomic variants and “abnormal” structural findings of the shoulder joint among a general population of middle-aged and elderly people.
• Second, to assess the CONCORDANCE of imaging findings with a) self-reported shoulder symptoms and b) findings in clinical examination.
• Third, to explore what are the main predisposing factors (DETERMINANTS) for a) structural changes, b) findings in clinical examination, and c) self-reported symptoms for shoulder pain.
• Fourth, in the subsequent LONGITUDINAL phase with 5- and 10-year follow-up, we will investigate the natural course of a) symptomatology and b) structural changes found in imaging.

What is the study design?

FIMAGE is a population based, longitudinal observational study aiming to produce novel data on the epidemiology and diagnostics of shoulder disorders. State-of-the-art imaging (3 T MRI scans) will be used to characterize the association between MRI findings and symptoms, and to clarify the relevance of imaging in the diagnostic pathway for patients with shoulder pain.

Where are we now?

The COVID-19 pandemic came at exactly the wrong time for this project—but like everyone else around the world – we were in the same boat. We worked hard while waiting for the situation to stabilize – as we felt that recruiting healthy volunteers during the pandemic was simply not an option.

Despite this setback – we secured the necessary funding during the pandemic and – finally – in early 2023 – we launched participant recruitment. From that point – the study progressed like clockwork: just over a year later – all 600+ participants had been interviewed – examined – and had their shoulders imaged.

Alongside data collection – we finalized and published the protocol article in December 2023: BMJ Open.

In 2024 – we focused on cleaning and refining the dataset – exploring the preliminary findings – and conducting statistical analyses. By the end of the year – we were finally able to start drafting the first manuscript. The initial FIMAGE paper is currently under review – and several others are in preparation.

Thomas and Saara have been the dynamic duo driving the work forward – with Simo and statistician Tommi Härkänen navigating the project. Rachelle Buchbinder and Teppo have lent their expertise behind the scenes to sharpen the message.

With any luck – FIMAGE will be a gift that keeps on giving for many years to come.

Project team

Saara Raatikainen – Tommi Härkänen - Pirjo Toivonen – Niko Sillanpää - Frank Bench – Ville Haapamäki - Kari Kanto – Antti Joukainen – Robert Björkenheim – Lasse Rämö - Anssi Ryösä – Petra Hagerström – Karin Sallmén

Contributors

Danielle Van der Windt– Juha Paloneva – Roope Kalske – Mika Paavola

‍

‍