Overutilization of shoulder magnetic resonance imaging as a diagnostic screening tool in patients with chronic shoulder pain

The Physical Therapist as a Musculoskeletal Specialist in the Emergency Department

“…7,35,56 Likewise, the unique examination and evaluation skills of physical therapists may limit expenses associated with overutilized and expensive services, such as diagnostic imaging. 11,23 In existing programs in the United States, official orders for imaging are submitted by physicians or designated staff. However, as is the case in the model program described in Tucson, Arizona, 82 physicians frequently solicit or entertain physical therapist recommendations whether or not imaging will be beneficial for certain patients.…”

MRI Before Radiography for Patients With New Shoulder Conditions

“…They found that with a thorough history and physical examination performed by an orthopedic surgeon and supplemented by radiographs, MRI changed the diagnosis or treatment in only 18% of cases. Bradley et al [2] suggest that a routine pre-evaluation involving MRI does not have a significant effect on the treatment or outcome and should not be used as a screening tool for atraumatic shoulder pain before a comprehensive clinical evaluation of the shoulder is done by a fellowship-trained shoulder specialist. These recommendations suggest an overall benefit for primary care physicians to refer patients to orthopedics and rheumatology colleagues after initial radiographs have been obtained.…”

“…Effective treatment depends on accurate diagnosis of the specific underlying cause of shoulder pain. The diagnosis is often made with a focused history, physical examination, and radiography [2][3][4].…”

Shoulder disorders—Part 2: Examination

“…For chronic shoulder pain of non-traumatic origin it does not appear MRI is a front line diagnostic test (Bradley et al, 2005). In total, 41% of 101 consecutive patients had a shoulder MRI prior to specialist evaluation by an orthopedic fellowshiptrained shoulder specialist.…”