MRIs
From the back pain blog at prolonews.com Ross Hauser, M.D.
Q. Is it necessary to have an X-ray or imaging study to do Prolotherapy?
A. These are usually unnecessary in the workup of acute onset back conditions, and are generally not required for a trial of Prolotherapy in most chronic cases that we see. Generally many of our patients have already had imaging studies. Degenerative changes and disc bulges are commonly noted, but their presence does not necessarily imply that they are causing the particular pain in that patient. Many traditional physicians overweight these imaging studies (which are filled with false negative and false positive findings) and use them to “fish” for a diagnosis, rather than using them to confirm a suspected clinical diagnosis derived from the history and physical.

The more common sources of back pain, lax or strained ligaments, usually do not show up abnormally on even the most sophisticated imaging studies. I may order new pictures (if prior films are dated) if a course of five Prolotherapy sessions fails to achieve the expected gains in the patient’s condition. The goal there is to rule out a condition which will necessitate surgical intervention. In general, Prolotherapiss are able to and find it preferable to evaluate pain complaints on the basis of history and physical examination alone, and new imaging studies are rarely needed or helpful.
 

MRI’s cannot tell a person what is causing their pain, it only confirms what is known by the history and physical examination.  Most MRI findings have nothing to do with why the person has pain and is thus the reason for most ‘failed surgery syndromes.’ Almost all people even after surgery are not pain free. Surgery for pain in the best case scenario should be done only after all of the conservative treatments have been tried and failed. This includes Prolotherapy!

Is Your Knee Pain Diagnosis Correct?
Marc Darrow, M.D.,J.D.
Diagnosis of knee injuries is, in my opinion, too dependant on many large machines and invasive techniques. Your knee hurts so you visit the orthopedic, here he uses his tools to figure out why your knee hurts. While some of these tools are very impressive indeed, are they accurate?

Once X-rays rule out problems with bones, a MRI (Magnetic Resonance Imaging) is brought in because of its ability to reveal soft tissue damage, but problems with the knee, especially the cartilage, can still be very evasive and hard to pinpoint. Studies have shown that the advanced technologies commonly used to diagnosis injuries are grievously insufficient to do the job.

In one study conducted by Dr. J.A. Lawrance of Oxford, England, MRIs had a success rate of only 11% in diagnosing partial anterior cruciate ligament tears. In yet another study, focusing on the knee, doctors compared the findings of standard x-ray tests and physical examinations on 210 people—all of whom were self-described as pain free at the time of the testing. Although none of the participants exhibited any pain or other symptoms of pathology, and considered themselves completely healthy in regard to their knees, the test results yielded dramatic evidence of physical problems and abnormalities, including an incidence rate of 80% or better for arthritis, patellofemoral crepitus (grinding) in 94% of the women, high percentages of asymmetry and hypermobility, and a dozen other problems to varying degrees. As the authors of the study noted: "Because patellofemoral crepitus is so common in both symptomatic and asymptomatic volunteers, the importance of this finding must be reevaluated as a surgical indication."

The conclusion is obvious: by offering "objective" evidence and a technology based rationale to over-eager surgeons, MRIs, X-rays and other advanced diagnostic techniques contribute greatly to promoting cases of unnecessary or even ill-advised surgery. The end result is more problems for the recipients of these surgeries.

Generally speaking, the most efficient and safe method for diagnosing a knee injury is a simple manual examination, coupled with extensive questioning of the patient to determine exactly what happened and where it hurts.

Research
Accuracy of magnetic resonance imaging of the knee and unjustified surgery
Magnetic resonance imaging of the knee is greater than 90% accurate in detecting intraarticular disease when performed and interpreted by musculoskeletal magnetic resonance imaging specialists in specialized medical centers. However, independent imaging institutions often offer less expensive services to health insurers. We wondered if the magnetic resonance imaging performed in our community is of equivalent quality and accuracy.


The results showed a false positive rate of 65% for the medial meniscus, 43% for the lateral meniscus, 47.2% for the Anterior cruciate ligament (treatment), and 41.7% for articular cartilage disease when compared with surgical findings. Accuracy rates were 52%, 82%, 80%, and 77%, respectively.

Thirty-seven percent of the operations supported by a significant disorder on magnetic resonance imaging were unjustified. Our findings highlight the consequences that may occur when basing medical care on cost rather than quality of care.

Ben-Galim P, Steinberg EL, Amir H, Ash N, Dekel S, Arbel R. Accuracy of magnetic resonance imaging of the knee and unjustified surgery. Clin Orthop Relat Res. 2006 Jun;447:100-4.