If you happen to be a social media enthusiast (some might say addict) and a physical rehabilitation or health care practitioner, an interesting story may have wandered across your news feed in the last week. It was a story from the New York Times where a very prominent surgeon in the U.S., Dr. James Andrews (if you follow sports at all, you have likely heard of) who specializes in shoulder surgery, took MRI images of 31 professional baseball players. These players were not injured in any sort of way, yet 90% of them had abnormal cartilage and 87% were diagnosed with rotator cuff abnormalities (such as tendonitis). This is problematic because when a person does have a injury, an MRI is very likely to detect some problem which may or may not be related to the person’s actual injuries. As Dr. Andrews states “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.,”
The shoulder is not the only body part where MRI’s have been found to be almost too good at the job they are supposed to perform. The knee and the low back are other examples of where the very sensitive images produced by MRI’s can be misleading. “It is a very sensitive tool, but it is not very specific. That’s the problem.” This is a quote from Dr. Bruce Sangeorzan who is an orthopaedist and professor at the University of Washington. In other words, MRI’s often detect problems that are not clinically relevant.
In Canada, the significant waits in the public queue for MRIs in relationship to musculoskeletal injuries can actually be of benefit for patients. When speaking of low back pain, new practice guidelines have been recently released in the U.S. for medical doctors recommending that they drastically reduce the number of MRIs, CT scans and x-rays that are ordered. As many as 25% of asymptomatic adults will display herniated discs in the lumbar spine and 60% will have degenerative changes on MRI imaging. Ordering these tests can be costly and not improve patient outcomes. Many medical doctors and chiropractors have been accustomed to ordering scans as part of normal practice even when they would not be beneficial to the end result. Some of this may because of a desire to appease the patients who want to “find out what’s wrong”. The problem with this is that an x-ray or MRI has to be clinically correlated with symptoms that the patient is displaying. If they are not, then the imaging has very limited value.
In my practice, I handle primarily musculoskeletal complaints from my patients. There is nothing more valuable in rendering a diagnosis to my patients than a thorough history and a complete physical, orthopaedic and functional exam. While imaging can be extremely valuable at times, the majority of cases do not require it and should only be used when clinically indicated, not as a part of every new patient complaint.
Feel free to submit any questions or comments to [email protected].
Thanks and have a healthy day!
Dr. Nimchuk is a chiropractor practicing at KLO Chiropractic Centre in Kelowna. He is also a full body Active Release Techniques® provider and Certified Exercise Physiologist®. He treats active patients from 2 months to 90 years old. Please check out our website at www.klochiropractic.ca
This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.