DC Medical Malpractice & Patient Safety Blog

It's natural to want an X-ray or MRI or some other kind of scan when you've had an injury that's so painful it hurts to use the involved body part. But many orthopedic surgeons are starting to speak out against the overuse of MRI scans in particular. They say it leads to over-diagnosis of injury and too much surgery on patients who don't need it.

To prove the point, orthopedist James Andrews did MRI scans on the shoulders of thirty-one professional baseball pitchers. Nine out of ten resulted in readings of abnormal shoulder cartilage, according to an article by the New York Times' Gina Kolata, who frequently writes about sports injuries and their treatment. Dr. Andrews' lesson: “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I."

The article also has a fascinating cautionary tale about a patient named Steve Ganobcik, who twisted his knee skiing, but was able to keep skiing for two more days on his vacation. He then underwent an MRI scan when the pain didn't go away. The orthopedic surgeon told him he had a torn ACL ligament in the knee and needed surgery. After two second opinion consultations, he discovered he had no torn ligament at all but a subtle fracture in one of his shin bones that needed no surgery.

The surgeon who steered him straight had his suspicions raised by Mr. Ganobcik's story. He could never have continued skiing with a torn A.C.L. The diagnosis “made no sense,” said Dr. Freddie Fu, chief of sports medicine at the University of Pittsburgh Medical Center.

This proves once again that the patient's story, as listened to by a careful and conservative doctor, can be the best guide to treatment.

Platelet-Rich Plasma injections are the latest treatment fad in sports medicine. Celebrity athletes like Tiger Woods and NFL player Hines Ward swear that P.R.P injections helped them miraculously recover from torn ligaments, and now regular patients are pressing their orthopedic surgeons to try the same thing. There's just one question: Do they work?

And the answer to that is: No one knows, because truly scientific studies have not been done in any rigorous way that would pass muster in a peer-reviewed journal.

The basic design of a scientific study would not be hard: Take any group of athletes who have suffered similar injuries. Half get injections with P.R.P. Half get injections of salt water. A coin flip decides who gets what. The injection syringes are disguised so that neither doctor nor patient knows if the injection is the "real stuff" or the placebo. Then you track the injury recovery of each patient and compare them.

But nobody has done that yet. It takes money to do such studies, and you can't make patients pay thousands of dollars for a treatment that they may or may not be getting if they participate in the study.

The companies that make the machines that extract platelets from patients haven't sponsored rigorous studies, and the National Institutes of Health hasn't either. Meantime, as Gina Kolata (herself a runner who tried P.R.P. two years ago and couldn't tell if it helped) describes in the New York Times, orthopedic surgeons who run sports injury clinics are being forced to decide between two models:

Are they operating boutique businesses, or trying to practice scientific medicine? Those who decide in favor of the business model are making a lot more money than their colleagues, even if they can't hold their heads up high as medical scientists.