5 Unnecessary Orthopedic Tests

X-Rays for a Sprained Ankle

Ankle sprains are common injuries that occur with slips, trips, and falls. Often it can be hard to tell the severity of the injury, as ankle fractures can also cause pain and swelling. However, your practitioner should be able to determine, just by examining you, if an X-ray is really necessary.

Your healthcare provider should be able to determine if you meet specific criteria, known as Ottawa criteria, that predict the likelihood of fracture, and thus the need for an X-ray. These criteria are based on the location of tenderness and the ability to walk four steps.

In many situations, patients have unnecessary ankle X-rays after sustaining a sprained ankle. A good clinical examination can help prevent these unnecessary tests.

MRIs for Back Pain

MRIs are very useful tools. You can see a lot on an MRI: bone, ligament, cartilage, muscle, fluid, organs, etc. However, some healthcare providers argue you see too much. In fact, MRIs show many signs of normal aging, even in people as young as their 20s, which may be confused with an abnormal finding.

One problem with MRIs of the spine is that once you've grown past your teens, you probably have normal findings on your spine MRI that may be interpreted as abnormal. For example, disc bulging is commonly seen in healthy, young people with no back pain. This finding is seldom the cause of back pain and can confuse patients trying to find the source of their pain.

MRIs and X-rays are seldom needed to diagnose back pain and usually are only performed if standard back pain treatments are not effective. There are also some warning signs your healthcare provider may look for to determine if imaging is necessary, but for the vast majority of patients, these are not helpful tests.​

Blood Tests for Joint Pain

The use of blood testing to diagnose joint pain may be very helpful, even necessary. However, ordering blood tests without understanding how the result will be used is generally not helpful. Blood tests are generally best used to confirm a suspected diagnosis, rather than as a substitute for a thorough history and physical examination.

The problem is, many blood test to diagnose types of arthritis can be falsely positive. That means that the result may be positive without the diagnosis of the underlying condition being present. For example, tests for rheumatoid arthritis (RA) can be positive in patients without RA, and may be negative in patients with RA.

Again, that is not to say that blood tests have no utility, but excessive use of these tests may lead to unnecessary treatment with potentially dangerous medications. Before obtaining a blood test, your healthcare provider should consider the possible diagnoses and ensure that the tests are performed for specific reasons, not just fishing for a possible problem. As stated above, if obtaining tests is just a fishing expedition, the results may prove to be falsely reassuring or lead to a misdiagnosis.

MRIs for Shoulder Pain

As is the case with back pain, MRIs of the shoulder often show findings that may be signs of normal aging. For example, rotator cuff tears become very common, especially as people age. While a rotator cuff tear is relatively uncommon in patients younger than 50, they become increasingly common to the point where more than half of patients over the age of 70 have a rotator cuff tear, and this is in patients with no symptoms of shoulder pain.

If surgeons operated on all elderly people with rotator cuff tears, they would be very busy. The truth is, that most rotator cuff tears, especially in patients over the age of 60, will improve with simpler, nonsurgical treatments.

New data is suggesting that labral tears are being diagnosed excessively in young patients with shoulder MRIs. Again, it is important to make sure any MRI findings are correlated to examination findings, and it is not just the test result that is being treated.

Bone Density Test in Low-Risk Patients

Bone density tests help to determine if a patient has the diagnosis of osteoporosis, a condition that causes thinning of the bone. There are specific criteria that are used to determine when this test is appropriate.

Having an abnormal bone density test may guide treatment, but the treatments often involve medications that can have significant side-effects. Patients who don't need a bone density test may be best served by waiting until they meet appropriate criteria for the test.