There is increasing evidence confirming that many things seen on MRI and blamed as the cause of the patient’s pain leading to invasive surgery are really normal findings. This has shown to be the case with knee MRIs. For years orthopedic surgeons have operated on almost all 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% .A patient went skiing and developed knee pain. An MRI seemed to show a tear in his ACL so two surgeons wanted to perform surgery. The third consultant told him his ACL was normal on exam and found an occult fracture that was the real cause of his pain when a bone scan was completed. The story highlights a huge problem. Many physicians have abrogated their exam to the MRI scanner. Too many patients come to us transfixed on their MRI.
Starting in middle age, asymptomatic meniscus tears are common; meniscus tears are part of normal aging. There are two distinctly different meniscus tear types: the normal degenerative tear and traumatic tear that’s really causing pain. A physical examination helps determine the difference, so beware of relying solely on an MRI to make a diagnosis without a thorough exam to confirm that finding.
As of late, there has been an explosion in the diagnosis and treatment of hip labral tears and femoral-acetebular impingement. There are many causes of hip pain other than FAI or hip arthritis. When the radiologist diagnoses FAI on an MRI, how certain is it that the actual cause of pain has been identified? One recent study of 21 professional and 18 college hockey players without any symptoms of hip pain indicated 77% had abnormalities on hip MRI. Another study looked at 200 mostly younger patients without hip pain and showed that FAI was present in 14% of patients. 1 in 4 of the men (24.7%) without any hip problems in this study were qualified as having FAI. I encourage all patients to get an accurate diagnosis before considering FAI or hip labrum repair surgeries. The most common cause of “hip” pain with a “negative” hip x-ray, positive MRI and an equivocal physical examination is referred pain from lumbar disc disease.
Mitchell B. Sheinkop, M.D.
1565 North LaSalle Street
Chicago, Illinois 60610