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Magnetic resonance imaging (MRI) is one of the modren imaging modalities used to diagnose the stuctural disorders in the body. In orthopaedics, its role has become tremendous and almost every patient with joint/ ligament/ tendon disorders is being subjected to this modality. However, it is like a double edged sword which should be used very judiciously.
The MRI uses electromagnetic waves to to give an indication of a distorted signal in the tissue. It has revolutionized the capability of the medical professionals to make an early diagnosis so that the treatment is instituted at the earlies possible time to avoid the irreversible damage of late diagnosis. In orthopaedis, the patients with the disorders like avascular necrosis (AVN) of the bones, musckuloskeletal infections/ tumours, disorders of spinal cord and vetebral column have benefitted tremendously by using the MRI to make an early diagnosis.
The modality, due to its high sensitivity, even picks up the slightest change in the signal in the tissue, and then is likely to be reported by the radiologist as a disorder. So much so that, the nomal variants of anatomy in certain patients have the potential to be picked up as an altered signal.
With the easy and universal availability of MRI, the medical professionals have developed a low threshold in ordering such modalities, many a times without having spent sufficient time on clinical examination of the patient. In doing so, the clinical skills are taking a back seat and the diagnosis is mainly made on the basis of MRI report. This has resulted in overdiagnosis and overtreatment of even the insignificant and subjective perception of symptoms especially in the patients with apprehensive and anxious personalities. The problem being global, the International Journal – JISAKOS (Offical Journal of International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine), in its editorial published in Janurary 2020 has glaringly highlighted this problem by publishing an editorial titled “Treat your patient, and not his MRI!”
Thus it is imperative on the part of the clinicians to keep their clinical skills updated and spend adequate time on clinical examination before ordering an MRI. The MRI should be used to corroborate the clinical diagnosis rather than making a diagnosis in the absence of a proper clinical examination.