The Limited Value of MRIs


The pitchers were not injured and had no pain. But the M.R.I.’s found abnormal shoulder 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 M.R.I.,” Dr. James Andrews, sports medicine orthopedist from Gulf Breeze Florida says.

Sports Medicine Said to Overuse M.R.I.s is a very valuable article from the New York Times Health section.  It deals with the widespread use and misuse of magnetic resonance imaging (MRI).  As you may know, these images can reveal all sorts of interesting information from inside our bodies.  Fractures, frayed tendons, fluid around a joint and tumors are just a few things that can we can see via an MRI scan.  The thing is, these images don’t always tell us why we’re in pain.

The quote at the top is from a study by Dr. Andrews in which he scanned the shoulders of a bunch of uninjured baseball pitchers.  Though they weren’t in pain, nearly all the scans revealed “abnormalities.”  The results are similar to a similar study of hockey players in which MRIs showed that 70% of the subjects show “abnormalities” in their hips.  The thing is none of the hockey players were injured or in pain.

The Times article discusses the profit motive behind both MRI scans:

“The price, which medical facilities are reluctant to reveal, depends on where the scan is done and what is being scanned. One academic medical center charges $1,721 for an M.R.I. of the knee to look for a torn ligament. The doctor who interprets the scan gets $244. Doctors who own their own M.R.I. machines — and many do — can pocket both fees. Insurers pay less than the charges — an average of $150 to the doctor and $960 to the facility.”

The article goes on to discuss a skier who was prescribed surgery for a torn knee ligament.  This prescription was based on an MRI and the tear was confirmed by a second opinion.  It was a third opinion and MRI however that showed that the ligament was not torn and surgery was not needed.  In this case, the third doctor noticed that the first and second assessments of the torn ligament did not match the symptoms of the man’s injury.  It seems the prior opinions relied only on what the MRI showed and not on a carefully considered history of the injury.

The overall message here is that MRIs can give us a lot of information but they may not tell us the whole story.  An MRI is not a perfect, magic tool that tells us exactly how to address our pain.  It seems the best doctors recognize this and are very careful to order MRIs only when truly needed.  Don’t be afraid to get multiple opinions on your injury.  If your doctor seems to be relying only on an MRI, keep looking around for more help.

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