So how do you do that from a research standpoint, factoring in all of those different variables to try to make sense of it?

Yeah, that's, that's a good question.

Of course, [sighs] not, not an easy, not an easy question to, to tackle because there are many different ways, and probably no- none of those ways are completely perfect, but...

So I think that what our, what we achieved with our sample was that we, we, we got a very, very good, um, certainty o- on the prevalence of those imaging findings in asymptomatic and symptomatic shoulders.

Uh, but then, of course, those imaging findings and symptoms, um- They could be caused, for example, looking at the shoulder also by other structures, not only the rotator cuff.

So how do you want to make sure that not, uh, osteoarthritis of the shoulder or AC joint problem, uh, biceps problems are the cause of symptoms? So, so the first adjustment that we, that we performed in addition to a, to the adjustment, uh, according to age, sex, uh, region, and education, which would be, um, general risk factors or, or, or factors affecting, uh, prevalence.

So, so we, we looked at other imaging findings and adjusted for those, and we saw that the difference in prevalence between symptomatic and asymptomatic shoulders was reduced a little bit, uh, regarding full thickness rotator cuff tears.

Is that, is that what you're describing from the study findings? And then can you talk a little bit more about just one of the big findings that we've kind of danced around, but the high prevalence of asymptomatic pathology that showed up on imaging?

So not only in specialty care, but we often order these as like a very early evaluation.

And I mean, I think that it makes a lot of sense in trauma care, for example.

We have a patient that arrives at the emergency department after an injury.

We are plain imaging.

We identify a structural problem, such as a displaced fracture, and then we restore anatomy.

And in these situations, fixing the structure leads most likely to better outcomes.

But the challenge comes when we extend the same way of thinking to non-traumatic conditions.

Is there a point with your sort of framework in mind and with the findings of the study in mind where you would think it appropriate for non-surgeons to be ordering shoulder MRIs where we might learn something?