MRI

 MRI are used as a diagnostic tool in the healthcare industry. There is some controversy in the validity of findings because often they can exist without pain. Here’s an overview to help you give patients appropriate information so that they can make an informed decision about their own care.

MRI Studies

Back

Jenson et al (1994) High prevalence of abnormalities in the lumbar spine on MRI examination of people without back pain.Only 36% had NORMAL disks at all levels.MRIs on individuals who had never experienced low back pain revealed that one third had a substantial spinal abnormality.52% of asymptomatic participants had at least one buldging disk or other MRI abnormality.“Conclusion, on MRI examination of the lumbar spine, many people without back pain have disk bulges or protrusions but not extrusions.Because bulges and protrusions on MRI scans in people with low back pain or even radiculopathy may be coincidental, a patient’s clinical situation must be carefully evaluated in conjunction with the results of MRI studies.”
 

Hip

AOSSM (2010) Pain free hockey players studied.54% had labral tears on MRI70% found to have abnormal pelvis or hips on MRI.
 

 

 

Knee

Beattie et al (2005) Meniscal degeneration and tears are highly prevalence in asymptomatic individuals using peripheral MRI.Forty four volunteers examined, age 20-68, with no history of knee pain. 60% showed abnormalities in at least three of the four regions of the knee.
 

Shoulder

Tempelhof et al (1999) Studies asymptomatic patients (ie no symptoms/no pain) 23% of all patients showed a rotator cuff tear.In group 1 (aged 50 to 59 years), 13% (22 of 167) of the patients had tears;

in group 2 (aged 60 to 69 years), 20% (22 of 108) of the patients had tears;

in group 3 (aged 70 to 79 years), 31% (27 of 87) of the patients had tears;

and in group 4 (age >80 years), 51% (25 of 49) of the patients had tears.

Shoulder II

Connor et al (2003) Eight of 20 (40%) dominant shoulders had findings (on MRI) consistent with partial- or full-thickness tears of the rotator cuff as compared with none (0%) of the nondominant shoulders.None of the athletes interviewed 5 years later had any subjective symptoms or had required any evaluation or treatment for shoulder-related problems during the study period.

 

Critical questions for cliniciansPrevalence of MRI findings in asymptomatic patients

  • Can you attribute back pain to MRI findings if 52% of asymptomatic (ie no symptoms) patients have abnormal findings or is this purely coincidental?
  • Can you attribute pain to a rotator cuff tear (based on MRI) if top athletes are performing at elite level with full or partial thickness tears with no pain and high level function?
  • How much can you rely on MRI imaging?

 

Critical Questions for patients?

  • Have you exhausted conservative therapy?     (ie relative rest, medication, physiotherapy)
  • Is an MRI going to change your management because if not do you want to risk negative effects of undergoing it? (non effective surgery, nocebo, changes within the brain).
  • Surgery is necessary in some cases but should only be under taken if conservative management has failed.
  • Have you truly exhausted physiotherapy?
  • Have you seen a specialist in your condition (ie chronic pain/sports/back/hip/etc)
  • Have you followed exact guidelines? Ie avoidance of agg factors/exercises as prescribed (not just when I’ve remembered!)
  • Given it an adequate time for tissue adaption and change?

Learn anatomy through MRI

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