MRIs are an incredibly powerful imaging tool for a physician. For better and sometimes worse they show an incredible amount of detail. When is comes to certain musculoskeletal problems, an MRI can help to make a diagnosis. I say help because on their own they shouldn’t make a diagnosis in the absence of other clinical findings that fit with the imaging findings. These other clinical findings can include how you describe your symptoms, your physical findings determined by a thorough physical exam, and sometimes labs as well.

So here’s a common clinical presentation: an individual with knee pain for several years that is progressively worsening has an MRI of the knee. The MRI shows a degenerated torn medial meniscus and wear and tear arthritis. Does this person need to rush to surgery to have their meniscus cut out to relieve their pain? Not necessarily. Forget about the fact that cutting out that meniscus makes you more prone to osteoarthritis in the future, that’s a topic for a different discussion. Equally important is the fact that this sort of meniscal finding is common as we age. It’s presence may not be truly pathologic and may not account for this person’s pain. So how should we use advanced imaging? Use it as a tool, not an all or nothing test that ignores other important findings. Combine the MRI with an understanding of anatomy and use of dynamic ultrasound imaging to target in on how to best help the patient.

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