Winnipeg Free Press - PRINT EDITION

Expensive MRI scan often not necessary

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Q: I have a sore hip that has been bothering me for two months. I would like to get an MRI scan but my physician feels it is premature to order (one). Why do I have to wait for an MRI to be ordered?

A: This test takes a picture of your injured/affected area while you are lying on a special table. There is no radiation exposure with an MRI, unlike X-rays and CT scans. The MRI shows all the soft tissue that we cannot see on a regular X-ray. It is an expensive test that has to be ordered based on true need.

It may seem obvious to you that you need an MRI for your sore area. However, not every injury, sore muscle or joint requires an MRI scan.

With the advent of many advanced technologies, it can be very tempting to skip right to a test such as an MRI. After all, we constantly hear in the media about athletes getting urgent MRI scans to figure out what is wrong with their knees or shoulders. Naturally, we wonder if we should also be getting quick tests.

First of all, before you begin to worry about whether you are going to get an MRI, it is important that your problem receives a proper diagnosis. A diagnosis is made by blending together your medical history and physical examination. An MRI is occasionally ordered when a diagnosis is not clear. However, the overwhelming majority of musculoskeletal diagnoses do not require an MRI as part of medical treatment.

MRI scans can be very useful for monitoring certain conditions previously identified on an earlier MRI, or other tests such as X-rays. And if an injury is not healing in the expected recovery time, an MRI is sometimes ordered to take a look at the anatomy in the injured area. The test should only be pursued if it will likely make a difference in the treatment. If the diagnosis and treatment are known, then an MRI is not necessary.

An MRI scan can show many soft-tissue changes (often minor) but not all these findings are related to your painful problem. A list of findings can cause anxiety and confusion for the patient and the results need to be explained as to how they may or may not relate to the patient's symptoms. It is definitely possible to have a normal MRI with pain symptoms or have an abnormal MRI with no symptoms.

Your own physician may follow a similar or different pattern for ordering MRI scans depending on his or her level of experience diagnosing and treating injuries and bone/joint/muscle problems. With experience and skill, a physician who examines many bone, muscle and joint problems will be able to diagnose injuries without relying on an MRI. It is important that you understand why an MRI may not be recommended. Ask your physician questions as to what investigative tests, if any, are being used to make a diagnosis.

 

Dr. Maureen Kennedy MD, CCFP, FCFP, MSc, PhD(c) Kinesiology, Dip. Sport Med., is a sport and exercise medicine physician at Sport for Life Centre, www.sportmedicinecentre.ca

 

Readers are welcome to ask Dr. Kennedy questions, but due to the volume of requests, replies are not guaranteed.

 

askthedoctor@freepress.mb.ca

Republished from the Winnipeg Free Press print edition October 4, 2011 C1

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About Dr. Maureen Kennedy

Born and raised in The Pas, Dr. Kennedy graduated from the University of Winnipeg Collegiate, earned a BSc and BA from the University of Winnipeg and an MD from the University of Manitoba in 1994. After certifying in family medicine at the University of Manitoba, Dr. Kennedy was awarded a two-year fellowship in primary care sport medicine at the University of Calgary Sport Medicine Centre. She completed this fellowship along with a MSc in Kinesiology at the University of Calgary. Her research focus was exercise counselling by family physicians. Dr. Kennedy further explored the use of exercise in medicine with PhD projects examining aerobic exercise in individuals scheduled for total hip or knee replacement surgery. She holds a diploma in sport medicine from the Canadian Academy of Sport Medicine and has served on numerous provincial and national committees for organizations such as the Alberta Medical Association, Canadian Academy of Sport Medicine, College of Family Physicians of Canada and Canadian Society for Exercise Physiology.

For the past 11 years, Dr. Kennedy has practised as a consultant in primary care sport medicine.

Dr. Kennedy's practice focuses on the diagnosis and treatment of injuries, muscle, bone and joint problems, orthopedic triage, weight management, osteoarthritis and dance medicine. She has served as the head physician for Alberta Ballet for the last nine years and has worked with the national women's hockey team along with many elite and amateur athletes in various sports. She points out that sport medicine physicians provide a tremendous service to the general public and the health-care system by shortening orthopedic waiting lists and providing non-surgical treatment options. "It's great to be back home in Manitoba and Winnipeg is a fantastic city," she adds. Readers can expect coverage on a wide range of fitness and health topics, including insider's tips on how to navigate the health-care system.

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