What’s on Your Hip MRI That Was Missed?
At Regenexx we pride ourselves in Concierge Procedural Medicine. What does that mean? In a world where patients get to spend less and less time with the doctor and more things get missed, our focus is to give patients more time and attention. Let me explain how the hip MRI above is a great example of what we do.
For every new Regenexx patient evaluation at our Colorado clinic, the treating physician spends a full hour with the patient. In a world where the average orthopedic surgeon is seeing 40 patients a day and the average pain management doctor is seeing 30, an hour is often more time than most patients have ever had the undivided attention of the doctor. The hip MRI above is a great example of what can happen in that hour. It’s also an example of what can’t happen in the few minutes allotted to the patient in the average orthopedic surgery office.
If you look closely at the image above, you’ll notice that the muscles look a bit like a steak in it’s plastic wrapper at the grocery store. That’s because both are axial slices through the structure. I’ve labelled a few of the muscles, so look now at the Iliopsoas (IP) and the TFL muscles that adjoin each other. Why does the IP muscle look like a lean steak and the TFL look like a fatty Kobe steak? Now compare the Gluteal muscles to the Sartorius and the Adductors – same stark difference! What’s going on? The muscles that look like lean steak all get their nerve supply from the upper part of the lower back (upper lumbar) and the muscles that look like Kobe steak are innervated by the lower part of the low back (lower lumbar). So just by paying close attention to this one slice of a hip MRI, we have a pretty accurate diagnosis that this gentleman with hip pain also has a serious nerve condition in his low back. However, this is the first time he’s been told that his hip MRI shows this problem. Why? With the hyper-fast world of medicine, nobody has time. So the radiologist and orthopedic surgeon missed this – as they were focused more on his hip arthritis.
The upshot? Concierge Procedural Medicine means that the doctor pays attention to you and pours over your images and history. It means that things like this low back nerve problem hiding in plain sight on a hip MRI are much less likely to get missed. How much time are you getting to spend with the doctor?