MRI's Do Not Always Detect The True Cause of Pain

I recently began treating a patient with the clearest symptoms identifying the cause of her knee pain. The mechanism of injury was clear. She noted that she performed a lot of housekeeping and so she was on her knees alot. She felt that this caused her to have the left knee pain.

I asked her to point to where she was having her knee pain. She pointed to the knee fat pads. These are located just below the knee cap just on either side of the patella tendon. The patella tendon is the tendon that attaches the knee cap to the lower leg bone that allows you to bend and straighten your knee joint. The fat pads act as a lubricant below the patella tendon to allow it to move without interfacing with the bones of the knee joint.

It was absolutely clear that when I palpated or touched the fat pads, that the patient's level of pain skyrocketed through the roof. This is known as point tender pain. It indicates that the tissue being touched, in this case the fat pads is the tissue creating the pain signal that the patient is complaining of.

The other clinical indicators were a strained and weak quad muscle (front thigh muscle) and thickening in the quads indicating that the quad had strained. Finally there was increased lateral movement of the knee cap in the knee joint. This indicates that the quad muscle is weakened and creating decreased upward force on the knee cap.

So this was a case that was neat and clean. The patient kneeled enough on her knee to irritate the fat pads. This created thickening in the fat pads which created pain at this location. The quads strained because they had to work harder to support the patient because when weight bearing, the pain at the fat pads was making it harder for the quads to contract because pain acts an inhibitory response to muscles contracting. There was thickening in the quads indicating that they had strained and there was increased lateral movement of the knee cap reinforcing that the quads were producing less tone due to the strain.

This is the kind of case I love. It presents with everything to understand the cause of the pain and therefore it is very easy to resolve the pain. That is of course if you understand how to use a clinical evaluation to establish the proper diagnosis.

Enter the orthopedist. He uses no clinical evaluation. He depends strictly on the MRI to establish a cause or diagnosis. So he has this woman get an 1800 dollar MRI which shows up a torn meniscus which he suggests requires surgery to resolve her pain.

Let's examine these events. The orthopedist suggests surgery for a torn meniscus that he found on an MRI. It doesn't matter that this patient's pain is unequivocally at her fat pads and a torn meniscus could never create pain at this location.

It doesn't matter that studies have shown that almost as many people with no pain can be found to have degenerative meniscal tears as those with pain. These tears found on MRIs were healed by the body and require no intervention, they simply exist.

The only thing that matters is that 1800 dollars was just spent to identify the cause of this woman's knee pain even though the cause was overwhelmingly obvious based on a clinical evaluation.

Now you're not this woman, why would you care if her insurance company paid for a completely worthless, unnecessary MRI? Because her insurance company may be your insurance company. And it isn't just her premiums that pay all the claims that the insurance company has to pay, it is all the premiums of all the insured in that insurance company. And if enough worthless claims have to be paid and there isn't enough money collected through the existing premiums, then your premiums have to be raised or the services the insurance will pay for will be reduced.

So this lady's situation better mean something to you just as your situation should mean something to her. There is a financial and physical toll that must be paid for using unnecessary MRIs to establish invalid diagnoses that lead to unnecessary medications and surgeries. The financial toll is to your premium that has to be raised to cover all these worthless claims and the physical toll is having pain that may be unending because an improper diagnosis was achieved by an invalid method. Think about that the next time your physician recommends an MRI as the method of establishing the cause of your pain.