Many Shoulder MRIs Unnecessary

Ultrasound, rather than MRI, is often appropriate imaging for shoulder injuries.

Orders for advanced shoulder imaging are often inappropriate, according to a study published in the Journal of the American College of Radiology.

Researchers from the University of Wisconsin School of Medicine and Public Health in Madison and Baylor College of Medicine in Houston, TX, analyzed shoulder MRI ordering practices in a Department of Veterans Affairs tertiary care hospital and explored the potential effects of shoulder ultrasound instead.

The researchers reviewed 237 shoulder MRI examinations to assess if MRI imaging was appropriate. The researchers also estimated the proportion of examinations for which musculoskeletal ultrasound could have been an acceptable substitute, had it been available. MRI findings were reviewed and assessed if ultrasound with preceding radiograph would have been adequate for diagnosis, based on literature reports of shoulder ultrasound diagnostic performance.

The results found that 106 of the 237 examinations (45%) were deemed inappropriate; 98 examinations (92%) had no preceding radiograph.

Inappropriate orders were more often from non-orthopedic providers (44%) compared to those from orthopedic specialists (17%). “In the 237 examinations, ultrasound could have been the indicated advanced imaging modality for 157 (66 percent), and most of these (133/157; 85 percent) could have had all relevant pathologies characterized when combined with radiographs,” the authors wrote. “Regardless of indicated modality, ultrasound could have characterized 80 percent of all cases ordered by non-orthopedic providers and 50 percent of cases ordered by orthopedic specialists.”

The researchers concluded that both orthopedic and non-orthopedic providers request advanced shoulder imaging that is not necessary, although more so from the latter group: “A combined ultrasound and radiograph evaluation strategy could accurately characterize shoulder pathologies for most cases.”