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Top Sports Med Docs Claim Huge MRI Overuse

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Sigvard T. Hansen Jr., MD, a professor of orthopedics and sports medicine at the University of Washington, doesn’t have much use for MRI. “I see 300 or 400 new patients a year,” Dr. Hansen, a foot and ankle specialist, told the New York Times. “Out of them, there might be one that has something confusing and might need a scan.”

The Times featured Dr. Hansen and other prominent orthopedists in a Friday story contending that MRI scans are overused in sports medicine. The piece was mostly anecdotal, though it did describe a few ad hoc studies. For example, James Andrews, MD, of Birmingham, Alabama, and Gulf Breeze, Florida, decided to test his own suspicions about MRI overuse by scanning the shoulders of 31 professional baseball pitchers who were evidently healthy and reported no pain.

MRI found abnormal shoulder cartilage in 90 percent of the pitchers’ shoulders and abnormal rotator cuff tendons in 87 percent. “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an MRI,” Dr. Andrews told the Times.

He was able to scan the pitchers’ shoulders because he’s the country’s go-to orthopedist for injured professional athletes. According to the Times:

He and other eminent sports medicine specialists are taking a stand against what they see as the vast overuse of magnetic resonance imaging in their specialty.

(Full disclosure: This writer is a friend of one of Dr. Andrews’ daughters and her husband, and once received a knee MRI ordered by one of Dr. Andrews’ partners at the time. The MRI confirmed a diagnosis of a torn anterior cruciate ligament, unfortunately.)

An MRI would show some joint abnormalities in almost any professional athlete, or any active amateur athlete for that matter. The Times quotes Bruce Sangeorzan, MD, professor and vice chairman of the department of orthopedics and sports medicine at the University of Washington, as saying that if a healthy, uninjured person goes for a run, a subsequent MRI will show fluid on the knee. That’s normal. But fluid can also indicate a stressed or cracked bone. Dr. Sangeorzan told the Times:

An MRI is unlike any other imaging tool we use. It is a very sensitive tool, but it is not very specific. That’s the problem.

MRI gets used often in sports medicine, the story points out, because it images soft tissues well, because patients often expect or even demand an MRI scan, because some doctors are afraid of malpractice charges if they fail to order a scan and miss a diagnosis, and, sometimes, because a doctor who owns a machine can make a lot of money ordering MRI.

It will be interesting to see whether such publicity about “excessive” scans, along with the current push against perceived imaging overuse, will prevent patients from demanding such scans anyway—and suing if they don’t receive them.

Related seminar: Musculoskeletal MRI

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