Saturday, October 29, 2011

THE OVER USE OF, AND LIMITS OF, MRI

This article in the New York Times extends findings on back pain to other joints, and confirms what many of us have long felt: a positive finding on a scan does NOT mean it is causing your pain AND there is no substitute for excellent history-and-physical.

"...scanned the shoulders of 31 perfectly healthy professional baseball pitchers. The pitchers were not injured and had no pain. But the M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent. “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.,” Dr. Andrews says...
"Dr. Green and his colleagues reviewed the records of 101 patients who had shoulder pain lasting at least six weeks and that had not resulted from trauma, like a fall. Forty-three arrived bearing M.R.I.’s from a doctor who had seen them previously. The others did not have scans. In all cases, Dr. Green made a diagnosis on the basis of a physical exam, a history, and regular X-rays. A year later, Dr. Green re-assessed the patients. There was no difference in the outcome of the treatment of the two groups of patients despite his knowledge of the findings on the scans. M.R.I.’s, he said, are not needed for the initial evaluation and treatment of many whose shoulder pain does not result from an actual injury to the shoulder.
"...Dr. DiGiovanni did a similar study with foot and ankle patients, looking back at 221 consecutive patients over a three-month period, 201 of whom did not have fractures. More than 15 percent arrived with M.R.I.’s obtained by doctors they had seen before coming to Dr. DiGiovanni. Nearly 90 percent of those scans were unnecessary and half had interpretations that either made no difference to the patient’s diagnosis or were at odds with the diagnosis."

1 comments:

troutbirder said...

Ouch. I believe although my partially torn rotator cuff followed a bycycling crash so tha pain was helped by therapy. Ah. The Golden Years. :)