MRIs over-used, misinterpreted? Not so surprising…
In the ‘80s, I recall experiencing minor knee pain and some clicking, so I went to see a sports orthopedist. He immediately ordered an MRI. When it came back, he said, “look,” pointing to some fraying and other stuff that he indicated wasn’t normal after he popped the images up a light board. His corrective solution to my pain was, “we need to do surgery.”
I wasn’t quite convinced. I mean, I had a little popping and a bit of discomfort but in my gut I thought surgery seemed like an excessive reaction. I told him I’d think about it, went home, and never went back.
I never told him that I became an ultra runner and ended up finishing the Western States 100 about two decades later.
In a thought-provoking but perhaps not-surprising article, New York Times health writer Gina Kolata revealed that even some orthopedists are now skeptical of MRI results that call for surgery and are calling for their colleagues to cut back.
A Florida orthopedist was suspicious of misleading scans so he performed a test, scanning the shoulders of 31 perfectly healthy professional baseball pitchers who were experiencing no pain or injuries. The MRIs found abnormal cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent.
“If you want an excuse to operate on a pitcher’s throwing shoulder, just get an MRI,” Andrews told Kolata in the article.
Just like the orthopedic surgeon who looked at an MRI of my knee two decades ago did. As a colleague once told me, heck, you go see a surgeon, what’s their answer going to be? Do surgery! Because that’s what they do.
Now Andrews and others are taking a stand against the overuse of magnetic resonance imaging – at least for this kind of treatment.
“An MRI is unlike any other imaging tool we use,” Bruce Sangeorzan, professor and vice chairman of the department of orthopedics and sports medicine at the University of Washington, said in the article. “It is a very sensitive tool, but it is not very specific. That’s the problem.” And scans almost always find something abnormal, although most abnormalities are of no consequence.
Take a look-see at a healthy, uninjured runner’s knee after a run and you will find fluid, he noted, adding that it means nothing. But in an injured person it may mean a stressed bone.
Bottom line for us at Adventure Network + Total Fitness Network, athletes have to take charge of their own care since many doctors don’t always have athletic interests at heart or the necessary sports background to make the best decision for an athlete. I for one have avoided surgery several times despite surgeons clucking their tongues over a diagnosis and noting surgery was needed. Instead I did some research, sought the advice of other sports doctors, went a little easy for awhile, made sure I did all the right stretching and strengthening, worked with a physical therapist, and in some cases tried alternative therapy.
This won’t apply to every MRI diagnosis or owie you may get, of course, since sometimes surgery may be needed. But this article and research presented by Kolata indicates that relying only on an MRI when deciding if you should subject yourself to a surgeon’s knife might not be the best practice.
–Therese Iknoian
The “Coach,” Therese Iknoian, has her Master’s degree in kinesiology with an emphasis in exercise physiology and is an American College of Sports Medicine-certified instructor. To read more about Therese’s coaching, outdoor and fitness background, click here.
