Shoulder impingement, MRI vs. X-ray (Full Version)

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dosrinc -> Shoulder impingement, MRI vs. X-ray (August 27, 2006 9:50:00 AM)

Evaluated a direct access patient a couple of weeks ago, determined he most likely had a fairly significant supraspinatus tear and that if he wanted Medicare to cover his therapy he would need a physician of record, also thought this would be a pretty good idea to determine the size of the tear and to help ascertain his rehab potential without surgical repair.

Long story short, he goes to the ortho and, having read up a bit on diagnosing RC tears, asks the physician to order an MRI, physician refuses MRI without X-rays first, patient doesnt want radiation exposure and wonders why physician wont order MRI when xray wont show the tear, physician again refuses MRI without xray first, pt. gets mad and leaves, then calls me and complains that I referred him to this guy, and states he will attempt his rehab on his own.

Can anyone come up with a good reason for the physician's actions?

Thanks,
Rick




drbuddy -> Re: Shoulder impingement, MRI vs. X-ray (August 27, 2006 11:24:00 AM)

Not sure why the doc wants an xray first, but you could explain to the patient that the radiation exposure from a shoulder xray is pretty much nil and even less of a concern if they are in their later years (assumption based on this pt having medicare).

What was the MOI? Maybe the ortho is ruling out fracture?




FLAOrthoPT -> Re: Shoulder impingement, MRI vs. X-ray (August 27, 2006 11:41:00 AM)

i think part of it is insurance protocol, the other part is that an x ray is still a better look at any possible space occupying or lytic lesions in the bone. Need to rule out life threatening things before you worry about a tear. In this day and age you need to C.Y.A. at all times. so, though it is stupid, I agree with the docs actions.




emad/emad -> Re: Shoulder impingement, MRI vs. X-ray (August 27, 2006 11:50:00 AM)

The doctor ought to reason his /her decion to the patient ,one of 2 thing happaned ,first the doctor told the patient his view and the patient refused to comply /accept that view .
The second this doctor dos not speak/explain to his/her patient .

May be the doctor does not agree with the therapist,s hypothesis of tear.
Cheers
Emad




ptdan23 -> Re: Shoulder impingement, MRI vs. X-ray (August 31, 2006 10:14:00 PM)

I agree with FLA...a lot of insurances require that the pt have an x-ray prior to having an MRI performed. I have heard in some instances of an MRI that was done being denied b/c an x-ray was not performed first. Doesn't make a lot of sense but since when does insurance make sense?

Dan, PT.




ragempt -> Re: Shoulder impingement, MRI vs. X-ray (September 1, 2006 1:19:00 PM)

Did the therapist explain that an MRI will only help the MD cut something out. Is the patient ready for surgery? This usually gets my patient off the MRI topic. Also he does not want an xray secondary to radiation but he has no problem getting an MRI? am I missing something?




rwillcott -> Re: Shoulder impingement, MRI vs. X-ray (September 1, 2006 7:18:00 PM)

I've learned that physicians don't take well to PT's advising them on what the patient requires. Most of the time that physician will be a bit irritated by this approach.

I find a note or quick phone explaining your results and hinting towards a tear helps. I typically will detail my findings and ask for "further investigation."

This usually works.

Rob




MPT -> Re: Shoulder impingement, MRI vs. X-ray (September 2, 2006 8:16:00 PM)

[QUOTE] an x ray is still a better look at any possible space occupying or lytic lesions in the bone. [/QUOTE]Fla: Are you sure about this? I was under the assumption that MRI had a higher sn/sp than x-ray for just about everything.




Chocco -> Re: Shoulder impingement, MRI vs. X-ray (September 6, 2006 9:30:00 AM)

One other benefit of xray over MRI is that 99 % of MRIs are taken Supine with scap stabelized. Xrays do not need to be taken supine and allow for a more accurate view of sub-acromial space and spurring with the shoulder in a funtional position if your looking at impingement as a possibility.




BRuchin -> Re: Shoulder impingement, MRI vs. X-ray (September 14, 2006 1:30:00 PM)

I was always told that it is protocol for the doctor to do x-rays first, then other radiologic imaging. It is protocol for insurance as well as treatment protocol.

For example, shoulder dislocation, acute stage. it is reduced, then post reduction x-ray, then rest, if needed later on, MRI to assess if there is a tear.

Most insurance companies will not pay for certain tests unless they follow a certain order.

Bryan




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