Magnetic resonance imaging, MRI, is widely used in musculoskeletal practice. However, when a medical professional considers ordering an MRI for a musculoskeletal injury, the image is utilized to assist in providing a piece of information after a comprehensive examination has been conducted. This includes the examiner looking above and below the area of symptoms in order to appreciate the interdependence of what one dysfunctional structure may be evoking on another area. Therefore, by ordering an MRI for the area that is symptomatic may not be warranted when the dysfunctional joint or tissue is coming from another source further up the kinetic chain. Thus, not only has time, energy costs been wasted in obtaining a ‘negative’ MRI result for something that is truly not the problem.
Another reason to order an MRI would be to confirm a hypothesis that may or may not require surgical intervention. Thus, asking the question if the patient would benefit from the MRI. The clinician utilizes a working knowledge of past experience, recent research, extrapolating information from objective tests and measures, as well as the response to current treatment in order to make the recommendation for further diagnostics to be obtained including an MRI.
MRI has the ability to detect cartilage, ligament, muscle, or bone injuries. However, an MRI can also assist in distinguishing between pathologies such as soft tissue or neuromuscular disease; ie Duchenne muscular dystrophy. Images from MRI can also assist in informing the viewer the status of the inflammatory process. For example, if a joint is highly irritable due to the inflammatory process, the physical therapy emphasis at that time is to calm the symptoms rather than working to make bigger gains in strength and range of motion.
In conclusion, an MRI serves in a multi-faceted capacity; however, its use needs to be truly warranted after a thorough physical examination has been completed. If a differential diagnosis is looming, there is not a clear understanding of the clinical tests and measures due to overlap with other conditions, or to obtain a level of irritability within the tissue, etc. an MRI may be beneficial to obtain.
You can also check out our blog post on CT Scans and their role in Physical Therapy.
Ref:
Deyle GD. The role of MRI in musculoskeletal practice: a clinical perspective. J Man Manip Ther. 2011 Aug; 19(3): 152–161.
