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5 Unnecessary Orthopedic Tests

Tests That Will Be Unlikely to Help You

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Updated September 30, 2013

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Doctors order many tests to aid in the diagnosis of ailments. Some tests are helpful, others may not be. When not performed for the right reasons, a test may even be dangerous, as it could guide an inappropriate or unnecessary treatment. Learn about some tests used in orthopedics that may make your think twice!

1. X-Rays for a Sprained Ankle

Photo © Mikkel William Nielsen
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.

2. MRIs for Back Pain

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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.

3. Blood Tests for Joint Pain

The use of blood testing to diagnose joint pain may be very helpful, even necessary. However, ordering blood tests without understanding how the result will be used is generally not helpful. Blood tests are generally best used to confirm a suspected diagnosis, rather than as a substitute of a though history and physical examination.


The problem is, many blood test to diagnose types of arthritis can be falsely positive. That means that the result may be positive without the diagnosis of the underlying condition being present. For example, tests for rheumatoid arthritis (RA) can be positive in patients without RA, and may be negative in patients with RA!

Again, that is not to say that blood tests have no utility, but excessive use of these tests may lead to unnecessary treatment with potentially dangerous medications.

Source:

Solomon DH, et al. "A computer based intervention to reduce unnecessary serologic testing" J Rheumatol. 1999 Dec;26(12):2578-84.

4. MRIs for Shoulder Pain

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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.

5. Bone Density Test in Low-Risk Patients

Bone density tests help to determine if a patient has the diagnosis of osteoporosis, a condition that causes thinning of the bone. There are specific criteria that are used to determine when this test is appropriate.


Having an abnormal bone density test may guide treatment, but the treatments often involve medications that can have significant side-effects. Patients who don't need a bone density test, may be best served by waiting until they meet appropriate criteria for the test.

Source:

JM Lane and M Nydick "Osteoporosis: current modes of prevention and treatment" J. Am. Acad. Ortho. Surg., Jan 1999; 7: 19 - 31.

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