5 Unnecessary Orthopedic Tests

Ankle sprains are common injuries that occur with slips, trips, and falls. Often it can be hard to tell the severity of the injury, as ankle fractures can also cause pain and swelling. However, your doctor should be able to determine, just by examining you, if an x-ray is really necessary.

Your doctor should be able to determine if you meet specific criteria, known as Ottawa criteria, that predict the likelihood of fracture, and thus the need for x-ray. These criteria are based on the location of tenderness and the ability to walk four steps.

In many situations, patients have unnecessary ankle x-rays after sustaining a sprained ankle.

_Source:

_{Jenkin M, et al. " Clinical Usefulness of the Ottawa Ankle Rules for Detecting Fractures of the Ankle and Midfoot" J Athl Train. 2010 Sep-Oct; 45(5): 480–482.}

MRIs are very useful tools. You can see a lot on an MRI: bone, ligament, cartilage, muscle, fluid, organs, etc. However, some physicians argue you see too much. In fact, MRIs show many signs of normal aging, even in people as young as their 20s, which may be confused for an abnormal finding.

One problem with MRIs of the spine, is that once you've grown past your teens, you probably have normal findings on your spine MRI that may be interpreted as abnormal. For example, 'disc buldging' is commonly seen in healthy, young people with no back pain. This finding is seldom the cause of back pain, and can confuse patients trying to find the source of their pain.

MRIs and x-rays are seldom needed to diagnose back pain, and usually are only performed if standard back pain treatments are not effective.

_Source:

_{Boden, SD, et al. "Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation" J Bone Joint Surg Am. 1990 Mar;72(3):403-8.}

As is the case with back pain, MRIs of the shoulder often show findings that may be signs of normal aging. For example, rotator cuff tears become very common, especially as people age. While a rotator cuff tear is relatively uncommon in patients younger than 50, they become increasingly common to the point where more than half of patients over the age of 70 have a rotator cuff tear--and this is in patients with no symptoms of shoulder pain.

If surgeons operated on all elderly people with rotator cuff tears, they would be very busy. The truth is, that most rotator cuff tears, especially in patients over the age of 60, will improve with simpler, nonsurgical treatments.

New data is suggesting that labral tears are being diagnosed excessively in young patients with shoulder MRIs. Again, it is important to make sure any MRI findings are correlated to examination findings, and it is not just the test result that is being treated.

_Source:

_{Yamaguchi K, et al. "The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders." J Bone Joint Surg Am. 2006 Aug;88(8):1699-704.}