Przejdź do treściAn MRI report is one piece of the diagnostic puzzle, not an indication for surgery by itself. Treatment decisions concern a particular patient: their pain, functional limitation, clinical examination, course of symptoms and treatment goals. The same MRI finding can have very different significance in two different people.
An imaging finding is not always the source of pain
MRI is highly sensitive and often shows age-related or degenerative changes that may not cause symptoms. Degenerative meniscal changes, spinal-disc abnormalities and rotator cuff tendon changes can all be present in people without pain. Finding an abnormality is therefore not the end of the diagnostic process. The finding still has to match the location, character and mechanism of the patient’s symptoms.
Five questions an orthopaedic surgeon considers before a treatment decision
1. Does the imaging finding match the symptoms?
A lesion described on MRI should fit the location of pain, loss of movement, weakness or instability. If the report concerns a different part of the joint from the area that is painful and reproduces symptoms on examination, the association may be incidental.
2. Does the clinical examination support that explanation?
Range of motion, strength, stability, swelling and provocative tests help determine whether an MRI abnormality has functional significance. MRI also cannot show everything that happens during movement or weight bearing.
3. Have the actual images been reviewed, not only the report?
The radiology report is important, but treatment planning also benefits from reviewing the images themselves. Location, extent, tissue quality, associated abnormalities and whether the finding genuinely explains the clinical problem can all matter.
4. Was MRI the right test for the question?
MRI does not replace X-rays when limb alignment, the weight-bearing joint space or the severity of some degenerative changes needs to be assessed. Nor does it replace dynamic ultrasound when the question concerns a snapping tendon, movement of a structure or a targeted image-guided procedure. The investigation should be chosen to answer the clinical question, not the other way around.
5. Is surgery likely to improve the problem that actually matters to the patient?
Even a genuine structural lesion does not always require an operation. Its natural history, the response to appropriate non-operative treatment, procedural risk and the patient’s functional goal all need to be considered. Surgery makes sense when there is a plausible mechanism for the symptoms and a reasonable likelihood that the procedure can change it.
When can MRI before consultation be particularly useful?
MRI can be very valuable after selected injuries, when an intra-articular lesion is suspected, in possible osteonecrosis, an occult fracture not seen on X-ray, infection or a tumour, and when earlier assessment and treatment have not explained persistent symptoms. That does not mean MRI should be the first test for every painful knee, shoulder or hip.
How should imaging be brought to a consultation?
- bring the actual images — on disc, another storage medium or through a working online viewer — rather than only a printed report,
- bring previous X-rays, ultrasound or MRI when comparison over time may be useful,
- note exactly where the pain occurs, which movements provoke it and what it prevents you from doing,
- summarise previous treatment and what effect it actually had.
The central principle
We do not operate on an image. We treat a clinical problem, and MRI is one tool for understanding that problem and planning management. The best decision comes from combining the history, physical examination and appropriately interpreted imaging.
References
- Poboży T, Konarski W, Janowski K, Michalak K, Poboży K, Domańska-Poboża J. Ultrasonographic Assessment of Meniscus Damage in the Context of Clinical Manifestations. Medicina. 2025;61(8):1339. DOI: 10.3390/medicina61081339.
- Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811–816. DOI: 10.3174/ajnr.A4173.
- Culvenor AG, Øiestad BE, Hart HF, Stefanik JJ, Guermazi A, Crossley KM. Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. Br J Sports Med. 2019;53(20):1268–1278. DOI: 10.1136/bjsports-2018-099257.
- Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. J Shoulder Elbow Surg. 2014;23(12):1913–1921. DOI: 10.1016/j.jse.2014.08.001.
This material is educational and does not replace an individual medical consultation.
Content prepared by: Tomasz Poboży - orthopaedic surgeon.