Years ago, if we wanted to order an MRI scan, we wrote a prescription for the test and the patient would go. At the time an MRI scan was the most sensitive test available to evaluate a joint or an area of the body. Most of these MRI scan offered inconclusive results and were very expensive. Today, insurance carriers require doctors to pre certify these expensive tests because too many tests were ordered.
In 2011, I published Cheating Mother Nature, what you need to know to beat chronic pain. The book discussed how the over ordering of MRI scans resulted in many older people having medical procedures with little or no benefit to them. A medical colleague who read my book said he believed he could not properly diagnose and treat a patient without one. We are all entitled to our opinions however, an MRI is helpful only if serious pathology that would not respond to rehab or chiropractic methods is suspected. An MRI will often cost more than the treatment of many painful joint problems. An MRI will never replace a holistic exam and appropriate treatment, however, it will often allow us to understand a problem after treatment had failed, or if an x-ray was unable to identify a cause for the complaint.
Many past medical procedures were MRI driven. If you had knee pain and the MRI scan showed a meniscus tear, the orthopedic would tell you surgery was needed. This past year, the New England Journal of Medicine showed there was little value to most of these surgeries that were expensive and risky. If you had a shoulder problem, an MRI may give a doctor permission to do an impingement surgery, which by the way was shown to have no value as we now understand that impingement problems are a result of posture what can be improved with exercise, foot orthotics and chiropractic methods or physical therapy methods.
While orthopedic practices were impacted by some of the studies mentioned, the MRI scan was regularly used to green light many procedures that we now know are often less helpful and safe than going to a chiropractor or therapist for appropriate treatment to a movement dysfunction problem such as hip, knee, shoulder or even back pain. Is the problem with the over ordering of MRI scans due to a lack of training for musculoskeletal disorders in primary care? Perhaps; chiropractors who practice as primary spine practitioners should be the first referral source for many common joint pains, as they are portal of entry physicians for these types of problems.
Recently, Howard Luks MD wrote a blog post on Kevin MD, a popular site for doctors to discuss problems within their profession. He also challenges this notion of an MRI for painful joints and brings up an important point that older patients will have changes in a joint, which does not mean the joint is abnormal for the patients age. It also does not mean the finding on an MRI will help us treat a patient better for their problem.
We do know the right referral will often result in the best treatment at the lowest cost. Unfortunately, many doctors often do not make the right referral and will instead send most of these cases to an orthopedic who will of course order an MRI of the joint to find out if they can do surgery. This is perhaps why we have the over ordering of MRI scans; old habits die hard.
Check out his interesting article below.
Not so fast with joint MRIs
HOWARD LUKS, MD OCTOBER 19, 2018
You wake up one morning, and your shoulder hurts. You’re not sure why, and blame it on your sleeping position. Perhaps you bend down to pick something up, and when you stand up your knee hurts. These are very common stories heard from patients in an orthopedic surgeon’s office. The onset of joint pain without significant trauma is very common over the age of 40.
Perhaps you wait a week, or worse, you run off to your primary care doctor immediately. Surely, pain means that something is wrong … right? Well, not so fast. Many of us will have shoulder, elbow or knee pain for no apparent reason as we age. Sedentary behavior is not tolerated well by our joints. Our tendons and muscles like to be exercised. They like the force or stress that resistive exercises provide. A joint supported by weakened muscle is a joint at risk for pain. That being said, even if you do exercise, you are still at risk of developing joint pain. So back to your aching knee or shoulder. What’s your next step?