How to read an MRI report of the spine, knee and shoulder: the main terms in plain language, and why treatment is never decided on an image alone.

The main rule

A finding on MRI does not always explain the pain. According to a systematic review, disc bulges are present in about a third of 20-year-olds without any pain and in most people over 60. The physician therefore matches the report with your symptoms and examination.

Spine

  • Protrusion — the disc bulges beyond the vertebrae on a broad base.
  • Extrusion — a herniation with a narrow neck; disc material reaches further.
  • Sequestration — a disc fragment has broken off. Large extrusions and sequestered fragments often shrink by themselves over months.
  • Stenosis — narrowing of the spinal canal or a foramen; both the measurements and the symptoms (leg pain when walking) matter.
  • Nerve root compression — a disc or bone presses on a nerve root; this matters more than the size of the hernia.
  • Modic changes — bone marrow changes next to a disc, seen with degeneration.

See a doctor urgently if you have numbness in the groin area, problems passing urine or increasing leg weakness. More: herniated disc and spinal stenosis.

Knee

Menisci (grades I–III), cruciate ligaments, cartilage (chondromalacia I–IV), synovitis and bone marrow oedema are covered in detail in How to read a knee MRI.

Shoulder

For the rotator cuff, reports say “tendinopathy”, “partial tear” (less than half the tendon thickness) or “full-thickness tear”. An acute full-thickness tear after an injury in an active person should be seen by an orthopaedic surgeon within the first weeks, as early repair is easier. More: rotator cuff tear.

Osteoarthritis grades (Kellgren–Lawrence)

  • 0 — no changes.
  • 1 — doubtful joint space narrowing, possible small osteophytes.
  • 2 — definite osteophytes, the joint space may be narrowed.
  • 3 — moderate narrowing, multiple osteophytes, sclerosis.
  • 4 — marked narrowing, large osteophytes, deformity.

What to send for a second opinion

Ideally the images in DICOM format, the report and medical summaries. We forward them to several clinics: physicians review the images themselves and give a preliminary opinion within 1–3 working days. Send your images.

Who it is not suitable for and possible risks

Contraindications

  • Active infection — at the injection site or systemic, with fever.
  • Active cancer or ongoing chemotherapy.
  • Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
  • Pregnancy and breastfeeding — the procedure is usually postponed.
  • A corticosteroid injection into the same area in recent weeks.
  • Urgent surgery, not injections, is needed if there is progressive leg weakness, numbness in the groin area or bladder dysfunction.

Possible risks

  • Pain and swelling at the injection site for 1–3 days.
  • Bruising where blood or fat tissue is taken.
  • Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
  • The effect may be absent or smaller than expected.
  • Injections into the intervertebral disc carry a rare risk of disc inflammation (discitis).

If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.

Scientific evidence

Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:

  1. Brinjikji W et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol, 2015.
  2. Jensen MC et al. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med, 1994.

Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised

Clinic and method matching — free of charge

Describe your case and attach your MRI report. We will identify clinics that use the relevant methods and forward your request to them. No obligation; we reply within 24 hours.

Send a request

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Frequently asked questions

What do “protrusion” and “extrusion” mean in an MRI report?

They describe how far a disc bulges: a protrusion has a broad base, an extrusion is a herniation with a narrow neck. These words alone do not decide treatment — what matters is nerve compression and symptoms.

Can an MRI report tell me whether I need surgery?

No, the decision is based on images, symptoms and examination together. Many MRI findings also occur in people without pain, so the physician interprets the report alongside your complaints.

Should I send the images or is the report enough?

It is best to send both the DICOM images and the report, as the clinic physician reviews the images personally. Without images, a preliminary assessment can be based on the report.

How does RegenPAS help organise treatment?

RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.

How much does treatment cost and how long do I need to stay in Munich?

The cost depends on the method, the diagnostics needed and the clinic itself: prices differ between clinics. We request offers from several clinics and send you their conditions and quotes so you can compare. Price guidance is on the treatment cost page. For an outpatient procedure, 2–3 days in Munich are usually enough: examination, procedure and follow-up visit.