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Shoulder and Elbow Doctor – Buffalo, NY

Live Receptionist for Appointments: M-F 9 am – 5 pm: 716-204-3200

Dr. Matthew DiPaola

Dr. Matthew DiPaola

Buffalo, NY Shoulder and Elbow Doctor

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Shoulder Arthritis: is MRI necessary?

If you have shoulder arthritis, an MRI may give you more information than you bargained for.

Most people think that you need an MRI to “see” everything that is going on in your shoulder. But it’s simply not true. And there are a few ways that you can be fooled by this line of reasoning.

1. You fail to put findings in context

I can show you MRI reports of normal shoulders that will scare the daylights out of you. These are full page documents that describe in great detail, essentially normal findings in medical lingo. Unfortunately as a layperson and even many medical professionals who are unfamiliar with the problem, most of this language will sound scary and can be misinterpreted.

What is normal for a 40 year old may NOT be normal for a 20 year year old. Be careful you aren’t over-interpreting “normal” findings. It can cost you sleep unnecessarily.

2. Not all MRIs are created equal.

Did you know that not all MRIs detect problems in your shoulder equally well?

One of the issues that comes up often in my practice is that referring doctors go ahead and order MRIs before a patient reaches me without truly considering whether they are ordering the right MRI for the job. It’s not their fault; they probably don’t know the difference. But there is a difference.

There are 2 main types of MRI that we use for the shoulder: ones with dye placed in the joint by a needle and ones without.

The dye (called contrast) gives a more detailed picture and can better outline tissues like the labrum.

The downside to using dye is that it requires an injection.

3. MRI is just not as good as direct visualization for diagnosing many subtle findings.

A recent study confirmed what I counsel patients about regularly: MRIs without dye do NOT always detect early arthritis well in the shoulder.

The researchers compared MRIs interpreted by a radiologist of patients who subsequently had an arthroscopic shoulder operation and found that the MRIs underestimated the amount of mild arthritis in many shoulders.

I’ve seen this in my practice as well. This usually happens in patients with mild arthritis. It is not severe enough to see well on xray because the cartilage wear may be spotty and there is not significant bone spur formation. So we order an MRI to look for other things like rotator cuff tears. L0 and behold, when the patient makes it to surgery we find some arthritis that the MRI never alluded to.

This is why I caution my patients not to put all of their faith in MRI. You have to understand that the MRI has weaknesss too. For conventional MRI, the ability to deftect mild cartilage wear is one of those weaknesses. Currently a shoulder arthroscopy does a much better job of detecting mild arthritis in the shoulder.

Bottom Line for Patients: even if your MRI does not indicate that you have shoulder arthritis, this does not mean that you DON’T have some mild arthritis in your shoulder. Directly looking at the cartilage is a more powerful tool for ruling out subtle arthritis.

Watch a video on shoulder arthritis HERE

Learn more about shoulder arthritis HERE

Learn more about shoulder replacement HERE

Category iconDr. DiPaola's Blog,  MRI,  Orthopedics,  Shoulder Arthritis,  Shoulder Problems and Treatments

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Meet Dr. DiPaola

Matthew DiPaola MD 2020

Matthew DiPaola, M.D

Dr. DiPaola is a Board Certified Orthopedic Surgeon and shoulder and elbow specialist. He has attained extensive training in the treatment of shoulder and elbow conditions and dedicates his practice to treating shoulder and elbow dysfunction with the most advanced surgical and non surgical … Read more about Matthew DiPaola, M.D

Contact Dr. DiPaola

Please contact me for an appointment or … Click here for more options about Contact Me

Are You Confused About Rotator Cuff Tears?

What are they? What is the right treatment for your rotator cuff? Why did your brother-in-law get surgery for his and you are only doing therapy? If you’re reading this you may already know how painful rotator cuff tears are. You yourself may have difficulty sleeping or lifting your arm overhead. … Read more about Are You Confused About Rotator Cuff Tears?

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If you are looking to:

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Click Here to Make An Appointment

At your visit I will personally see you and:

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...and get you on the road to a better night’s sleep.

In Good Health,
Matthew DiPaola M.D.

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