Do I Need An MRI?

As we treat more patients, we gain wisdom about their types-of-problem. And part of that wisdom should be: “I am treating this person in front of me, and they are not a statistic or a trend”.

And we must be careful with MRI results. We all have anxious patients who arrive with an MRI under their arm. “Dear Doctor, the report says I have damage to my rotator-cuff tendon, and labral damage. Please, can you help me!”

A research study by, “Lee et al” performed MRIs on the dominant shoulders of asymptomatic elite volleyball players. All of them (yes, 100%!) had pathological findings, ranging from partial cuff tears in 65.4%, tendinopathy in 88.5 %, and labral tearing and/or fraying in 46.2%.

Such findings are not new. MRIs of the lumbar spine of 98 elite junior tennis players (mean age, 18 years old) showed abnormalities in 94 of them. Disc degeneration was noted in 62.2%, and disc herniation in 30.6%.

Are these findings specific for athletes? It appears not. They are only, perhaps, more extreme for athletes. In a study of asymptomatic non-athletes, the prevalence of abnormal hip findings was 73%.

And for 44 asymptomatic individuals (from 20 to 68 years) with no history of knee pain, injury or bone or joint disease, MRIs of the knee showed abnormality in 43 individuals.

All the elite volleyball-players in Lee’s study were asymptomatic, but they all had cuff or labral lesions. Now, cuff and labral lesions in athletes have a bad prognosis for return to competition after repair. Several studies have shown that surgery for overhead-athletes is rarely successful. Andrews et al reported that 92% of overhead-athletes failed to regain their previous competitive standard, after rotator-cuff repair-surgery. That is, only one-in-ten were ‘cured’ (as they and their trainers and teams would say)! Another study showed that only 63% of overhead athletes were able to regain their previous competitive level after SLAP lesion repair surgery.

What should we conclude from all this? Do not treat the MRI! Treat the patient!

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