Why Imaging Is Often Overused


X-ray, MRI, and diagnostic ultrasound are some of the great imaging tools we have at our disposal.  They can be extremely helpful with many musculoskeletal conditions.  They can show structural changes like arthritis, disc herniation, and soft tissue tears.  They can help us make a decision on who is the right doctor to see (surgeon, chiropractor, etc.).  So what happens when someone has pain but imaging, such as an x-ray or MRI tells us absolutely nothing?  On the other hand, can someone have positive MRI or x-ray findings but no symptoms?  The point of all this is not to say that imaging is not important because it can be, but how can we determine if someone needs it?

Many studies have confirmed that some low back MRIs of people that are asymptomatic will still show structural abnormalities like arthritis and disc herniation.  Here is study using diagnostic ultrasound to observe rotator cuff tears.  It concluded that roughly two thirds of the group with rotator cuff tears had NO symptoms.  Well known sports orthopedist Dr. James Andrews is quoted as saying: “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an MRI”.  This was in response to a study he performed.  In that study he found that in a small group of professional baseball pitchers with no symptoms, 87 percent had both cartilage and rotator cuff damage.

The point of all this is not to say that imaging is not important because it can be.  However we have to keep in mind that the correlation between imaging results and patient symptoms is very poor.  Instead MRI or x-ray findings are only considered along with all other factors (exam findings and history).  Imaging is never the first or last word.  It is unfair for someone who is suffering from pain to be told that nothing is wrong with them just because their MRI is negative.  Also, consider the false positives.  It may be unnecessary to opt for surgery because a structural abnormality is found on MRI findings before considering more conservative measures first.

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