May 22, 2020

The Magnetic Resonance Imaging test, or MRI, is performed at a hospital or imaging center. The patient lies on a tray, which slides into a tube, and after a series of very loud clicks made by a large magnet, a series of images is created. The images are read or “interpreted” by a radiologist, who writes a report that becomes the “official” result of the MRI. Unlike x-rays (which see bones), MRIs are particularly helpful when there is damage to soft tissues like ligaments (in the knee), tendons (rotator cuff in the shoulder), or disks (in the spine).

So, what is the point of having a surgeon review the images?

Recently, I had an MRI of my shoulder, for pain that had persisted for over six months. Every month, the pain worsened. Any movement that involved extending my arm or raising it above my head hurt. The first orthopedic surgeon I saw took x-rays and said I had tendonitis. He gave me exercises. They helped for a while. My internist then sent me for an MRI. The radiologist reviewed my images and also said I had tendonitis.

Then I saw the second orthopedic surgeon.

“I disagree with the radiologist,” he told me. “You see this little white triangle?” he asked, pointing to a tiny area on the computer image of my shoulder. “That is a bone spur on the tip of your acromion. And see this light color strip here, that is your rotator cuff, and where the color is disrupted is a hole that the bone spur is digging in the tendon.” He explained that the bone spur and the hole did not line up in the view we saw, but if I lifted my arm, they would be in the same place. If he took out the bone spur, my pain would go away. If he did not, it was just a matter of days or weeks before that hole turned into a full tear of my rotator cuff.

So, I could have a minor surgery now, or wait and have major surgery later. I chose the minor surgery now. And while no surgery in a pandemic is minor, compared to the rotator cuff repair I had to the other shoulder six years ago, this was a breeze.

So how did the radiologist miss this bone spur, but the orthopedic surgeon caught it? Think of it this way: The image is like a map of a city, and the radiologist is looking at the entire map, interpreting everything he sees. The surgeon, armed with the details of where I hurt, knew to focus only where the pain was. He knew what he was looking for, and where on my shoulder he should look. So, he did not have to study the map of the entire city – just the intersection where my pain was located.

In my case, had I just gone for physical therapy, I would have made my shoulder worse, and I would have ended up in surgery, but much more complex and difficult surgery. It is often a good idea to consult a surgeon early in your treatment.

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