Is your Abnormal Shoulder MRI Really Normal?
Is your abnormal shoulder MRI really normal? I’ve blogged before on a very scary trend that continues despite the evidence-many things seen on MRI and blamed for the cause of the patient’s pain that lead to invasive surgery are really normal findings. This has shown to be the case with knee MRIs. For years we doctors have chased around phantom meniscus tears while modern studies have shown that an awful lot of patients without symptoms have meniscus tears on their MRI. A recent NY Times piece highlighted a study by an orthopedic surgeon that showed the same thing for shoulder MRI. The study involved scanning the shoulders of 31 perfectly healthy baseball players without pain. Despite imaging normal players, the shoulder MRIs found abnormal cartilage in 90 percent and abnormal rotator cuff tendons in a whopping 87%! I love the quote from the surgeon, “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.” The patient example mentioned in the NY Times story is typical of our experience. This patient went skiing and developed knee pain. An MRI seemed to show a tear in his ACL so two surgeons wanted to yank it out and replace the ligament. The third surgeon told him his ACL was normal on exam and found an occult fracture that was the real cause of his pain. The story highlights a huge problem. Many physicians have abrogated their exam to the MRI scanner and don’t practice the common sense combination of looking at the picture, listening to the patient, and performing a thorough exam. The upshot? We have many patients who come to us transfixed on their MRI as if it were the Oracle from Delphi and many have been told that they need invasive surgeries simply based on the MRI with little exam or history to corroborate what’s on the films. This includes patients who are about to have their entire knee, hip, or shoulder joint replaced but who actually have pain coming from somewhere else. If you’ve had a 5 minute evaluation where much of the time was spent transfixed on the MRI and very little was spent asking about the who, what, when, and where and on a good old fashioned exam, you may need a second opinion!
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