AANA Lab Course 915 - Foundations in Arthroscopy-When do I order an MRI-John Orwin, M.D.

When do I order an MRI-John Orwin, M.D.

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This document, authored by Dr. John F. Orwin, explores the appropriate use of MRI in orthopedic practice, particularly shoulder pain assessment. It criticizes the prevalent overuse of MRI as a screening tool without proper history, physical exam, or simpler diagnostic tests like radiographs. Ordering MRIs prematurely may lead to overdiagnosis, unnecessary treatments, and high healthcare costs.

Key points and recommendations include:

1. <strong>MRI as a Diagnostic Tool:</strong> MRI should be ordered only after comprehensive patient history, physical exam, and initial radiographs. MRI findings often do not correlate directly with symptoms, and many abnormalities (e.g., rotator cuff tears) are present in asymptomatic individuals, especially with aging.

2. <strong>Cost Considerations:</strong> MRI scans are costly (e.g., around $3,150 for knee MRI, $3,800 for shoulder arthrogram), contributing to substantial annual healthcare spending (estimated $78 billion on MRIs yearly in the US). Using MRI without necessity drives up costs with limited patient benefit.

3. <strong>Clinical Examples:</strong> Cases presented emphasize tailored MRI use:
   - Acute traumatic rotator cuff tears post-injury require early MRI for surgical planning.
   - Chronic rotator cuff tears and arthritis seen on radiographs may not benefit from MRI.
   - Conditions like calcific tendinitis and adhesive capsulitis usually do not need MRI.
   - Some diagnoses (e.g., Parsonage-Turner syndrome) are better evaluated by EMG rather than MRI.

4. <strong>Guiding Treatment, Not Just Imaging:</strong> Patient symptoms and clinical examination should guide management, not MRI findings alone. MRIs should aid decision-making but not dictate treatment indiscriminately.

5. <strong>When MRI Is Helpful:</strong> MRI is valuable when needing to confirm suspected tears, evaluate ganglion cysts, identify symptomatic labral pathology, rule out malignancy/infection, and detect occult fractures.

<strong>Summary:</strong> Avoid MRI as a routine screening tool for shoulder pain. Prioritize history, physical exam, and radiographs. Use MRIs judiciously when results influence treatment decisions, improving patient care while limiting unnecessary procedures and costs.

Keywords

MRI use in orthopedics

shoulder pain assessment

overuse of MRI

rotator cuff tears

cost of MRI scans

clinical guidelines for MRI

diagnostic imaging

EMG vs MRI

MRI in treatment planning

healthcare cost reduction