Treat the patient, not the scan...

Griff · Dec 19, 2012

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Very interesting findings in this article:

Prevalence of Abnormal Hip Findings in Asymptomatic Participants: A Prospective, Blinded Study
Brad Register, Andrew T. Pennock, Charles P. Ho, Colin D. Strickland, Ashur Lawand and Marc J. Philippon
Am J Sports Med December 2012 vol. 40 no. 12, 2720-2724

Abstract

Background: The prevalence of abnormal magnetic resonance imaging (MRI) findings in an asymptomatic population has yet to be determined.

Purpose: The purpose of this study was to assess a cohort of asymptomatic people to determine the prevalence of hip lesions.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Forty-five volunteers with no history of hip pain, symptoms, injury, or surgery were recruited for enrollment in this institutional review board–approved study. The subjects underwent a unilateral MRI scan with a Siemens 3.0-tesla scanner. The extremity side evaluated by MRI was alternated. All MRI scans were reviewed by 3 fellowship-trained musculoskeletal radiologists. The scans were mixed randomly with 19 scans from symptomatic patients to blind the radiologists to the possibility of patient symptoms. An abnormal finding was considered positive when 2 of 3 radiologists agreed on its presence.

Results: The average age of volunteers was 37.8 years (range, 15-66 y); 60% were men. Labral tears were identified in 69% of hips, chondral defects in 24%, ligamentum teres tears in 2.2%, labral/paralabral cysts in 13%, acetabular bone edema in 11%, fibrocystic changes of the head/neck junction in 22%, rim fractures in 11%, subchondral cysts in 16%, and osseous bumps in 20%. Participants older than 35 years were 13.7 times (95% CI, 2.4-80 times) more likely to have a chondral defect and 16.7 times (95% CI, 1.8-158 times) more likely to have a subchondral cyst compared with participants 35 or younger. No other joint lesions were associated with age. Male subjects were 8.5 times (95% CI, 1.2-56 times) more likely to have an osseous bump than female subjects. No other joint lesions were associated with sex.

Conclusion: Magnetic resonance images of asymptomatic participants revealed abnormalities in 73% of hips, with labral tears being identified in 69% of the joints. A strong correlation was seen between participant age and early markers of cartilage degeneration such as cartilage defects and subchondral cysts.
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WillTrekker · Dec 26, 2012

Amen to that... for you can't see pain on any rads. And while some Pods still insist on having an MR for every Neuroma... although small ones don't show up (duh!), then they're just not sure if they should proceed w/ surg despite P.E., Subj findings, evid (S&S), as well as a pos block, and failed 'roid injxn as well as other pall tx... well, then I'm sure most you cd plainly c that exc/resxn is clearly indicated. Case closed, or open remove, then shut! -WG :):santa2:

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