MRI for Osteoarthritis : does it tell us anything?

This X-ray is normal but would a MRI for osteoarthritis show any changes?

This X-ray is normal but would a MRI for osteoarthritis show any changes?

MRI and CT scanners have been around for some time now. It has always been assumed they are better than X-rays as they give more detailed information. However this study calls into question the real benefit of using MRI for osteoarthritis diagnosis and whether in fact good old fashioned X rays do a better job after all!

This is the study which is done as part of the Framingham Osteoarthritis Study, investigated whether MRI for osteoarthritis was useful. It was published in The BMJ.

The study will continue investigating these people for at least 5 years so this is just the start. It began by taking

710 people aged >50 who had no radiographic evidence of knee osteoarthritis (Kellgren-Lawrence grade 0) and who underwent MRI of the knee.

They then went on to divide the participants into groups by age, sex, body mass index and whether they had pain or not. They compared the radiographic (X-ray) finding to the MRI findings for each group.

This was the results:

The higher the age, the higher the prevalence of all types of abnormalities detectable by MRI. There were no significant differences in the prevalence of any of the features between BMI groups. The prevalence of at least one type of pathology (“any abnormality”) was high in both painful (90-97%, depending on pain definition) and painless (86-88%) knees.

Several interesting facts come out of that:

1. It didn’t matter whether you were fat or not there was no difference in your MRI changes. Now how many here have been made to feel their OA is all their fault because they were overweight? I have – even though I was diagnosed by X-ray aged 28 when I was a shadow of my current self! (I did smoke 30 cigarettes a day though which I stopped aged 32 and put on nearly 3 stone!).

2. It didn’t matter whether your knee was painful or not, nearly everyone had abnormalities on their MRI. Funnily enough that is not so different to X-ray. We were always taught at College the amount of degeneration did not correlate to the amount of pain. Some people had major changes and virtually no pain while others had minor changes and loads of pain.

I believe there is a good reason for this. NOT ALL THE PAIN OF OSTEOARTHRITIS COMES FROM THE ACTUAL WEARING OF THE  JOINT! In many folks a large part of the pain is from the muscles, tendons and ligaments around the joint which is not shown on X-ray and has not been included as an abnormality in this research. Treat those and nearly everyone will suffer less pain.

Is MRI for Osteoarthritis a Waste of Time, Money and Resources

In a word “Yes!” but then so are X-rays! I believe there is little benefit as diagnosis can easily be made from taking a good case history and a physical exam. The only reason to do any sort of imaging is if you believe the person is a candidate for surgery or if the person fails to respond to physical therapy. Click on the link to find out how to diagnose OA without taking an X-ray as many practitioners agree with me on this one.

Findings on either X-ray or MRI for osteoarthritis can actually have a damaging effect. For example if the the person has a niggly knee, you take an X-ray and find they have pretty bad OA . This can have a negative effect psychologically. They worry and stress their knee is worn which makes their perceived pain worse and they stop leading a normal life as they worry it will make their OA worse. As a practitioner it can be negative as well. You worry whether they should get surgery done even though they have only a little pain and will probably feel a whole lot better with your treatment!

In the UK, where I practiced, suspicion of OA is not a good clinical reason to X-ray. I never did and only bothered if the person didn’t respond to 3 weeks of treatment. Then I would X-ray to make sure nothing else was going on.

Paula Radcliffe. Photo by Tom Corser Licensed under Creative Commons Attribution ShareAlike 2.0 England & Wales (UK) Licence:

Can you tell Paula Radcliffe bobs her head quite dramatically from a still photo.                                       (Photo by Tom Corser Licensed under Creative Commons Attribution ShareAlike 2.0 England & Wales (UK) Licence:

To use static pictures to how something functions is pretty much useless in my opinion and that is why these researchers found what they did.

Can you tell Usain Bolt’s running action is so smooth from a photo?

Could you tell Michael Johnson’s or Paula Radcliffe’s running actions were weird from a still photo?

No – because a single, still shot does not give you the motion. It is the same for a moving joint.

Checking the way the joint functions and how it affects the person’s life will give far more information than either an X-ray or MRI for osteoarthritis.

After all do you care how you look on X-ray or MRI- they are hardly going to go in the family photo album!

Or do you care how much pain you have and how you can lead your life?

If that is what you care about sign up for my free 3 day course to really learn what you can do to improve the function of your joint. Don’t bother using either your hard earned money or your valuable insurance on an X-ray or MRI for osteoarthritis. Instead use it to make a positive difference to how you feel.

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