MRI Not Always Needed For Shoulder Pain Sioux City
When Do I Need an MRI for Shoulder Pain?
An MRI scan (Magnetic Resonance Imaging) is a valuable tool for evaluating muscle, tendon, and shoulder joint pain. It helps us to look inside the shoulder joint to identify labrum tears, ligament tears, or a loose body floating throughout the joint. There are some types of injuries that require immediate surgical correction. However, most shoulder injuries that we see in the office do not require surgery, or even an MRI.
A thorough physical exam will test your passive and active range of motion. Your active range of motion is how far you yourself can move your shoulder before the onset of pain. Your passive range of motion is how far your chiropractor can move your shoulder before it starts to hurt. Differences between active and passive range of motion give us information about your shoulder injury. In addition, the location and intensity of pain tells us about your shoulder injury and its severity. Supraspinatus, or rotator cuff tendinitis, is a very common injury to the tendon, in the place where it inserts on the humerus. In fact, most cases of shoulder pain are symptoms of mild to moderate tendon injuries, which respond to conservative care. If the physical evaluation shows decent active and passive range of motion, and this finding is combined with mild to moderate orthopedic testing that indicates a supraspinatus pain as being the only injury present, then there probably is not a need for an MRI.
To reiterate: most mild and moderate shoulder sprains can be successfully evaluated during orthopedic and physical exam testing. If your provider is very confident in the findings and suggesting for sprains and strains, an MRI is probably not going to provide value to your treatment. Would you rather spend your time and money confirming the physical exam findings, or working to get the shoulder better? If we do not think it will add value to your treatment, we are not likely to order an MRI.
Medicare and major insurance companies have established guidelines for MRIs. These guidelines suggest an MRI if the examiner thinks there is a fracture or infection, or if there is severe trauma that could produce multiple types of internal joint damage. Many sets of guidelines specify four weeks of conservative chiropractic or physical therapy treatment before an MRI is performed. Other insurance carriers require four weeks of anti-inflammatory medication along with therapy prior to approving an MRI for evaluation.
If you are not getting better during treatment, or have not seen improvement after four weeks, then an MRI is often desirable for the sake of further evaluation. The MRI will let us know if we are already on the right path, and just need to give the treatment more time. Alternately, MRI findings may help us shift treatment plans, or tell us that there is something more significant going on inside the shoulder.
As mentioned earlier, most mild to moderate rotator cuff, supraspinatus, bicep tendinitis, teres syndrome, or ligament sprains respond to conservative treatment. Most people begin showing an improved pain-free range of motion within one to two weeks. They may describe an improved ability to perform more home, work, or recreational activities before experiencing pain. They often describe a decreased intensity of pain with motion (such as that sharp stabbing pain when reaching above their head).
I once heard someone describe their philosophy for MRI evaluation of shoulder pain this way: If it looks like a duck, orthopedically tests like a duck, walks like a duck, and gets better with treatment like a duck, then we are probably on the right path and don’t need an MRI. If however it stops looking like a duck, then we will immediately get an MRI for further evaluation of the shoulder.