Magnetic Resonance Imaging
(MRI) is thought of as the gold standard diagnostic tool for finding
abnormalities of the bones, muscles and ligaments of the body. But there are many reasons you should be wary
of the results of your MRI in the future.
A New York Times article by Gina Kolata in October 2011
commentated on a study where the authors took 31 professional baseball pitchers
who were both injury and pain free and gave them a MRI. The results found abnormal shoulder cartilage
in 90% of the athletes and abnormal rotator cuff tendons in 87% of the athletes. Let me reiterate that these were athletes
that did not complain of any previous injury or past or current pain in their
shoulder. Dr. James Andrews, a top
sports orthopedic surgeon put it perfectly.
“If you want an excuse to operate on a pitcher’s throwing shoulder, just
get an MRI.”
In that same month a Journal, Health Services Research, came out with a study titled “The
Relationship between Low Back Magnetic Resonance Imaging,
Surgery, and Spending: Impact of Physician Self-Referral Status” The objective of the study was to examine the
relationship between use of MRI and receipt of surgery for patients with low
back pain. Many results came of this
study but the most ground breaking was that among patients receiving orthopedic
surgery, the likelihood of having spinal surgery increased by 34% if the orthopedic surgeons owned
the MRI machine. The moral of the story
may be to ask your doctor if he or she owns the MRI equipment or benefits
financially from you getting the MRI before consenting to imaging.
In November of 2011 an article by Tim Flynn et. al was
published in the Journal of Orthopeadic
and Sports Physical Therapy (JOSPT).
This article, “Appropriate Use of Diagnostic Imaging in Low Back Pain: A
Reminder that Unnecessary Imaging May Do as Much Harm as Good,” described an
MRI as only a picture of a single moment in time. This picture, let us say of a disc lesion,
gives us no compelling evidence that the patient will have prolonged course of
impairment or disability. In simple
terms, the MRI has no way of looking at function.
Below are two MRI images.
The first image (A) shows a small disc bulge in the bottom 1-2
joints. The second image (B) shows disc
bulges at multiple levels of the spine with compression of the spinal cord and
nerves that innervate the leg.
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| B - Multi Level Disc Bulges |
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| A - 1-2 Disc Bulges |
Now that you have seen those pictures, I’ll briefly tell you their story. Image “A” belongs to a 32 year old man with a small disc bulge on MRI and this small bulge has lead to severe back and leg pain which is debilitating. This patient has missed work for multiple months out of the year secondarily to pain. Image “B” shows a spine with severe degeneration and multiple disc bulges. This is an image of a 62 year old. This man has no pain and regularly hikes all around the world as a hobby.
 |
| "A" |
 |
| "B" |
Once again we can see that the MRI does not tell the whole
story. Do not let that next MRI harm
you!
References:
1. http://blog.myphysicaltherapyspace.com/2011/11/education-to-avoid-harm.html?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+EvidenceInMotion+%28Evidence+In+Motion%29
2. J Orthop Sports Phys Ther
2011;41(11):838-846, Epub 3 June 2011. doi:10.2519/jospt.2011.3618
