Overuse of MRI in Sports medicine; it does not just sport medicine that overuses them

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The NY Times recently reported on the overuse of MRI in sports medicine. Years ago, it was easy to order an MRI for almost any condition, because that was what real doctors did. The problem with the MRI is that it is quite sensitive and tells us nothing about the mechanism of what created the problem. The insurance companies, recognizing that the test had been overused, hired companies like care Cores who set up protocols for when they will certify someone to have an MRI done. This has decreased the amount of the tests however, it is often an absence of diagnostic skills that causes the health care provider to order the test because, without good manual diagnostic skills for the musculoskeletal system, diagnosis is purely hit or miss. Sometimes, as in the article that follows, a sports injury or other activity injury created the problem, however, there was often a mechanical mechanism that caused the failure or the pain in the area. Cruciate ligament injuries and shoulder injuries come to mind with this example. Unfortunately, they still teach health care providers to evaluate the area of pain, rather than understand the problem and what caused it. The devil is in the details. The NY Times featured an article discussing the overuse of MRI, specifically with regard to sports medicine. I can remember one time a while ago I had a patient who had a bump on the top of her foot that was moving. I was unsure what it was so I recommend she see her podiatrist. Her podiatrist did not know as well. He ordered an MRI. The diagnosis was a ganglion (inflamed tendon with a fluid-filled sac - generally harmless but can be uncomfortable). While these are usually seen on the arms and wrist, I had never seen one on the legs or feet. The podiatrist should have known what it was and quite honestly, I felt embarrassed about an MRI being ordered for a non-condition like this which should have been able to diagnose by sight and feel alone.

Sports Medicine Said to Overuse M.R.I.'s

By GINA KOLATA Dr. James Andrews, a widely known sports medicine orthopedist in Gulf Breeze, Fla., wanted to test his suspicion that M.R.I.'s, the scans given to almost every injured athlete or casual exerciser, might be a bit misleading. So he scanned the shoulders of 31 perfectly healthy professional baseball pitchers. Keep reading here