What do you mean, “…sway you against MRIs.”?
No one has attempted to do that here.
Interesting discussion, I have a colleague who administers the Boards for Orthopedic Surgeons in my state. He said that if a surgeon suggests an MRI to diagnose OA he will fail his Boards. I thought that was interesting.
I also came across these stats some time ago:
%40 of asymptomatic people have bulging discs on MRI
In 40 year old asymptomatic men and women, %50 will demonstrate disc degeneration and signs of injury, endplate changes, foraminal stenosis, and facet joint degradation on spinal imaging.
After successful rotator cuff repairs and clinically sound examination, %90 of patients imaging will indicate abnormal signaling.
Imaging of the asymptomatic general population shows a %40 prevalence of rotator cuff tears across all age groups.
In patients over the age of 70, %67 will have an asymptomatic rotator cuff tear.
%35 of collegiate b-ball players with no knee pain will have significant abnormalities on their MRI scan.
[quote]CroatianRage wrote:
What do you mean, “…sway you against MRIs.”?
No one has attempted to do that here.[/quote]
LMFAO
On 8-25-14 this was posted:
[quote]BHOLL wrote:
[/quote]
The article, unless I misread it, implies MRIs are often unwarranted.
Then I thought of my gf and how MRI helped her docs figure out exactly what’s wrong with her shoulders. That’s why I posted my comment yesterday with a link to an OPPOSING point that favors MRI when necessary.
I read every single post in this thread. The same asshat who posted the link was pretty damn clear on his stance against MRIs. Then he got called out for pretending to be an expert. So he conveniently resurrects a thread that’s been dormant for seven months to try to get in a dig. Awesome comedy right there.
[quote]Dr. Pangloss wrote:
Interesting discussion, I have a colleague who administers the Boards for Orthopedic Surgeons in my state. He said that if a surgeon suggests an MRI to diagnose OA he will fail his Boards. I thought that was interesting.
I also came across these stats some time ago:
%40 of asymptomatic people have bulging discs on MRI
In 40 year old asymptomatic men and women, %50 will demonstrate disc degeneration and signs of injury, endplate changes, foraminal stenosis, and facet joint degradation on spinal imaging.
After successful rotator cuff repairs and clinically sound examination, %90 of patients imaging will indicate abnormal signaling.
Imaging of the asymptomatic general population shows a %40 prevalence of rotator cuff tears across all age groups.
In patients over the age of 70, %67 will have an asymptomatic rotator cuff tear.
%35 of collegiate b-ball players with no knee pain will have significant abnormalities on their MRI scan.
[/quote]
I’ll just take one example from your list and ask you a question. Let’s take the 40% people who have bulging discs but show no symptoms. Don’t you think this information is pertinent in designing a corrective program so the bulge does NOT eventually rupture?
Human nature’s a funny thing. People have this mentality ‘if it ain’t broke, don’t fix it’ So why is it so many feel fine one week and then the next something snaps?
[quote]MinotaurXXX wrote:
I’ll just take one example from your list and ask you a question. Let’s take the 40% people who have bulging discs but show no symptoms. Don’t you think this information is pertinent in designing a corrective program so the bulge does NOT eventually rupture?
Human nature’s a funny thing. People have this mentality ‘if it ain’t broke, don’t fix it’ So why is it so many feel fine one week and then the next something snaps? [/quote]
How do you propose we find those %40 who are asymptomatic, yet show bulging discs on an MRI?
[quote]Dr. Pangloss wrote:
[quote]MinotaurXXX wrote:
I’ll just take one example from your list and ask you a question. Let’s take the 40% people who have bulging discs but show no symptoms. Don’t you think this information is pertinent in designing a corrective program so the bulge does NOT eventually rupture?
Human nature’s a funny thing. People have this mentality ‘if it ain’t broke, don’t fix it’ So why is it so many feel fine one week and then the next something snaps? [/quote]
How do you propose we find those %40 who are asymptomatic, yet show bulging discs on an MRI?
[/quote]
I’m no doctor but common sense tells me some percentage will eventually have pain. They’ll shift from no symptoms to having them.
If the doc simply prescribes pain killers, it really doesn’t address the issue. If the doc does a comprehensive eval, including MRI if/when necessary, then the patient knows what he’s dealing with and (if he’s smart) will be proactive about it.
A patient doesn’t go to the doc unless they’re having pain or some kind of discomfort. Are you suggesting prophylactic MRIs?
I think you’re overestimating the power of the MRI in changing the course of treatment. A doctor who diagnoses what they believe to be a herniated disc will give their patient the same recommendations, whether they have imaging in front of them or not.
It’s not that imaging isn’t useful, it’s that in many, many cases (like OA of the knee and rotator cuff tears) it doesn’t change the initial course of treatment.
Once that initial course of treatment is exhausted (PT, RICE, etc) then an MRI might be called for. Or, again in the case of OA, it still doesn’t change the course of treatment - in this case surgical intervention.
[quote]Dr. Pangloss wrote:
A patient doesn’t go to the doc unless they’re having pain or some kind of discomfort. Are you suggesting prophylactic MRIs?
I think you’re overestimating the power of the MRI in changing the course of treatment. A doctor who diagnoses what they believe to be a herniated disc will give their patient the same recommendations, whether they have imaging in front of them or not.
It’s not that imaging isn’t useful, it’s that in many, many cases (like OA of the knee and rotator cuff tears) it doesn’t change the initial course of treatment.
Once that initial course of treatment is exhausted (PT, RICE, etc) then an MRI might be called for. Or, again in the case of OA, it still doesn’t change the course of treatment - in this case surgical intervention.
[/quote]
I disagree.
The sooner the patient knows the full extent of her injury, the sooner she can take corrective action.
^^^
To add to this:
http://mlb.mlb.com/news/article.jsp?ymd=20140706&content_id=83357612¬ebook_id=83359034&c_id=col
"Michael Cuddyer is scheduled for a follow-up MRI on his fractured shoulder July 21 when the Rockies return to Colorado for their first home series after the All-Star break.
If all is healed as expected, he’ll begin his strengthening and rehab with a mid-to-late August return in mind. If it isn’t healed, Cuddyer will spend a few more weeks in a sling…"
Sure, we’re talking about a major league slugger getting paid little over 30 mil for three years. Obviously, there’s a lot at stake.
But why shouldn’t such proactive measures - when called for - be applied to a D1, D2, or even the weekend athlete?
This is what I mean by judicious use of MRIs as necessary. I’m not arguing for knee-jerk let’s MRI everything approach. But I hear these arguments that downplay the need for them and I just shake my head.
“Mr. Minotaur, thank you for coming in. Based upon your symptoms, it’s my diagnosis that you have osteo-arthritis in both your knees. I’d like for you to start PT immediately, here’s a list of activities you should avoid, and here is a script for a pain killer if it gets too uncomfortable. In 2-3 years, you’ll most likely require total knee replacements.”
“Mr. Minotaur, based upon the physical exam I’ve performed and the weakness you exhibit, I believe you have a partially torn rotator cuff. We’ll start with 12 weeks of PT and re-evaluate every 3 weeks. Here are a list of activities you should avoid…”
“Mr. Minotaur, based upon the flexion-intolerant nature of your pain my clinical diagnosis is Discogenic LBP. While we don’t know whether a disc is necessarily causing the pain, we know that you can’t tolerate flexion and this will guide out therapy. Of course you understand that a large part of the population would exhibit disc degeneration on imaging, but would show no symptoms therefore an MRI wouldn’t change the course of treatment in this case.”
[quote]MinotaurXXX wrote:
But why shouldn’t such proactive measures - when called for - be applied to a D1, D2, or even the weekend athlete?
[/quote]
Because resources aren’t infinite.
I read the journal article describing Drew Brees’s PT after his labrum surgery. He was getting therapy 5 times a day. In a world with infinte resources, we’d all be receiving PT 5x a day.
This isn’t that world.
[quote]Dr. Pangloss wrote:
[quote]MinotaurXXX wrote:
But why shouldn’t such proactive measures - when called for - be applied to a D1, D2, or even the weekend athlete?
[/quote]
Because resources aren’t infinite.
I read the journal article describing Drew Brees’s PT after his labrum surgery. He was getting therapy 5 times a day. In a world with infinte resources, we’d all be receiving PT 5x a day.
This isn’t that world.
[/quote]
Of course it’s not. That’s when the observant physician would pause and say, ‘Maybe in your case, we need an in depth look.’
[quote]Dr. Pangloss wrote:
“Mr. Minotaur, thank you for coming in. Based upon your symptoms, it’s my diagnosis that you have osteo-arthritis in both your knees. I’d like for you to start PT immediately, here’s a list of activities you should avoid, and here is a script for a pain killer if it gets too uncomfortable. In 2-3 years, you’ll most likely require total knee replacements.”
“Mr. Minotaur, based upon the physical exam I’ve performed and the weakness you exhibit, I believe you have a partially torn rotator cuff. We’ll start with 12 weeks of PT and re-evaluate every 3 weeks. Here are a list of activities you should avoid…”
“Mr. Minotaur, based upon the flexion-intolerant nature of your pain my clinical diagnosis is Discogenic LBP. While we don’t know whether a disc is necessarily causing the pain, we know that you can’t tolerate flexion and this will guide out therapy. Of course you understand that a large part of the population would exhibit disc degeneration on imaging, but would show no symptoms therefore an MRI wouldn’t change the course of treatment in this case.” [/quote]
If the patient wanted to know exactly what’s going on so he can (with the help of his strength and conditioning Coach) layout the blue print for corrective exercise programs that basic PT sessions don’t always address, the patient has that right.
btw, are you an actual medical doctor? Or is your user ID just a nod to Voltaire?
Nod to Voltaire. I’m not any type of doctor at all, not even a phd.
[quote]MinotaurXXX wrote:
If the patient wanted to know exactly what’s going on so he can (with the help of his strength and conditioning Coach) layout the blue print for corrective exercise programs that basic PT sessions don’t always address, the patient has that right.
[/quote]
Of course they do. The underlying theme to the entire conversation is “Who is going to pay for it?”.
If you’re a cash-pay patient, the MRI clinic will be happy to MRI any part of your body you’d like, as often as you’d like.
But that’s a different conversation. The conversation at hand is the clinical importance of the MRI in diagnosing various maladies.
[quote]Dr. Pangloss wrote:
[quote]MinotaurXXX wrote:
If the patient wanted to know exactly what’s going on so he can (with the help of his strength and conditioning Coach) layout the blue print for corrective exercise programs that basic PT sessions don’t always address, the patient has that right.
[/quote]
Of course they do. The underlying theme to the entire conversation is “Who is going to pay for it?”.
If you’re a cash-pay patient, the MRI clinic will be happy to MRI any part of your body you’d like, as often as you’d like.
[/quote]
You’re talking to a guy with congenital scoliosis and bum knees from mountain biking like there’s no tomorrow. Now that I’m in a place in my life where finances are reasonably stable and a long healthy pain free life is the goal, I want ALL the relevant facts so I can make the best possible decision with eyes wide open.
If my knees ever give out (which I don’t they will because my current program is excellent and I just respect my health more in general) I WON’T be satisfied with what the doc THINKS it might be. I’d want to cover all bases so I can get to addressing the issue pronto.
[quote]Dr. Pangloss wrote:
But that’s a different conversation. The conversation at hand is the clinical importance of the MRI in diagnosing various maladies.
[/quote]
Maybe this is why we’re not quite seeing eye to eye.
The conversation at hand, from my point of view, is that MRIs have a place. Sometimes it’s unnecessary and therefore unimportant; other times it can be vital and therefore very important. As I stated in my post yesterday, one article from the New York Times (or anywhere else) isn’t going to dissuade me.
Minotaur you’ve made up an argument. BHOLL’s initial advice was that an MRI wasn’t indicated because conservative methods had not been attempted. No one is against MRIs. An MRI won’t help any more than a physical exam in planning a S&C program–in fact, it will likely not help at all in planning a S&C program. A patient doesn’t necessarily have the right to request advanced imaging. Doctors have an obligation to not harm the patient. Even though MRIs don’t emit ionizing radiation “abnormal” imaging puts psychosocial stress on the patient and can absolutely condition the them to experience chronic pain. Curiosity is not an indication for imaging.
With all that being said, no one is against MRIs.
BTW, BHOLL and 56 have some weird history so I wouldn’t take all that stuff too seriously.
[quote]CroatianRage wrote:
Minotaur you’ve made up an argument. BHOLL’s initial advice was that an MRI wasn’t indicated because conservative methods had not been attempted. No one is against MRIs. An MRI won’t help any more than a physical exam in planning a S&C program–in fact, it will likely not help at all in planning a S&C program. A patient doesn’t necessarily have the right to request advanced imaging. Doctors have an obligation to not harm the patient. Even though MRIs don’t emit ionizing radiation “abnormal” imaging puts psychosocial stress on the patient and can absolutely condition the them to experience chronic pain. Curiosity is not an indication for imaging.
With all that being said, no one is against MRIs.
BTW, BHOLL and 56 have some weird history so I wouldn’t take all that stuff too seriously.[/quote]
Then how do you explain the following post from the guy who started this thread?
From 1-28-14:
[quote]irfhdah wrote:
My wife finally made me go get an MRI. The doctor said I have a less than 25% tear in my rotator cuff (it is right at the top of the subscapulus where it meets the superscapulus. He said just dont raise my arm laterally above my shoulder, avoid inward pressing movements and rest for 3 months. If it still hurts come back and see him.
[/quote]
Looks like it’s a good thing the OP took the advice to get MRI so he had a better idea of his injury.
btw, I think I’ve pretty good picture of both 56 and this bholl. From the looks of it the latter was giving advice on a subject he wasn’t an expert on, got called out on it, then just oh so conveniently resurrects a thread 7 months old to post a link…?
Like I said: LMFAO