Magnetic resonance imaging of the extremities. A critical appraisal of utilization by an orthopaedic service
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Objective: To assess the utilization of MRI by the orthopaedic department of a University Teaching Hospital for the investigation of musculoskeletal conditions affecting the extremities.Design: During a 12 month period, all patients referred for MRI of an extremity were enrolled in the study. Clinical details of presentation, surgical management and outcome were prospectively recorded.Patients: 91 patients were included with a mean age of 35 years. The following anatomical areas were scanned; knee (48), shoulder (31), hip (3), soft tissues (6), brachial plexus (2), wrist (1).Results: A significant finding was reported in 56 patients (62%) and surgery was undertaken in 42. With regard to MRI of the knee the sensitivity of the investigation was 95%. Four patients were referred inappropriately for the investigation.Conclusions: Selective referral for MRI for the investigation of the injured knee represents an appropriate use of this scarce resource. It allows arthroscopy to be targetted to those patients in whom the procedure will be therapeutic. Unnecessary diagnostic knee arthroscopy can and should be avoided. The study supports increased orthopaedic access to MRI for non spinal conditions in the future.
Key wordsMagnetic resonance imaging utilization Appendicular skeleton Extremity Arthroscopy Cost effectiveness Appropriate use
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