A Magnetic Resonance Image (MRI) is an advanced diagnostic test can be incredibly helpful. I am a big believer in them.
In fact, this week I’ve had two to the knee pictured here. I unfortunately twisted it running on the beach on the last day of my recent trip so I thought this would be a good time to blog about this important topic.
I went to my first physical therapy session early this morning hoping my partially torn medial meniscus doesn’t need surgery. I experienced what my clients go through on a daily basis – more about that later.
Why not just rely on an x-ray?
Magnetic resonance imaging uses powerful magnets and radio frequencies to create a 3-D image that clearly shows bones, cartilage, blood vessels, muscle, tendons, and ligaments.
An x-ray only creates a flat image of the skeleton. An x-ray is useful to detect broken bones, but not to diagnose herniated disks and soft tissue injuries, which are common types of car crash injuries. The surgeon also had me x-rayed.
Furthermore an MRI does not release radiation. Although the small dose of a single x-ray is safe, your doctor will probably recommend an MRI if you are pregnant, have an underlying medical condition, or have had multiple recent x-rays or CT scans. Because your doctor can refer you to an MRI without concern about radiation exposure, he can do so in gray-area cases in which he only suspects an injury.
Is an MRI worth the cost?
There is of course one disadvantage to an MRI — the price. It can cost $2,000.00 or more, although your health insurance or my ability to secure my clients a much lower price should moot this concern. When deciding if it’s worth the cost to you, ask these questions:
- Will an MRI more accurately diagnose my injury?
- Does my doctor or do I suspect that I may need surgery?
If the answer to either is yes, you should have one.
What happens during an MRI?
You will lie completely still in a giant tube for 10 – 30 minutes, depending on whether you are in an open MRI (which is very useful if you are claustrophobic or overweight) or a smaller closed one.
You should know that the pounding noise in the closed one is very loud. I was given headphones but they didn’t begin to block out the deafening sound. I had been told I could have an open MRI – which was still very loud — but the results were not as good as the surgeon desired due to the age of the machine. You should confirm this with your surgeon and the facility. I was fortunately able to drastically negotiate down the costs for both and you might be able to do so as well.
What do the results mean?
Your doctor will explain what the findings are and even show you the images, as he is doing in the photograph. You may also be given a copy of the film and can later ask to see the radiologist’s written report.
But there are complicated medical terms that are used, sometimes interchangeably and even incorrectly, so here are the basic terms that are used in cervical and lumbar injuries:
- Bulging – when the jelly-like material that makes up the nucleus pulposis (interior) of the intervertebral disc swells and moves outward but remains intact. The key is how large the bulge is. It is usually measured in millimeters (mm).
- Protruding – when the bulge is larger, unless the disc is protruding on a nerve root or other part of the spinal canal or column.
- Extruding – when the disc material moves into the spinal column and even pinches or compresses a nerve root, often causing substantial pain and needing surgical repair.
- Herniated – when the annulus (outside fibrous ring) of the disc is ruptured by the bulge. It can even break material off, usually requiring immediate surgery.
- Degenerative – when that the disc is damaged due to natural body processes and aging, not from the car accident. However this is often hard to diagnose, depending on the crash, type of injury, the length of time after the accident until the MRI was taken, the age and physical condition of the patient, prior injuries, and other factors. Many doctors will assume that anyone over a certain age, say 40, has degenerative discs, and that the car accident did not damage them at tall, which is a misconception that a personal injury lawyer must correct.
Using an MRI to prove causation
We use your MRI to prove that your injuries were proximately caused by your crash. We can also see if pain or numbness from a herniated cervical (neck) disk that has radiated into your shoulder, shoulder-blade, arm, and head, and from your lumbar (low back) disc into your legs and feet is caused by one of the above disc abnormalities. An MRI image can explain why you are having this radiation of pain into other areas of your body under what is called a dermatomal pattern.
When insurance company adjusters and attorneys try to claim that an accident victim was faking or exaggerating whiplash an MRI image can show the extensive damage to the vertebrae, spinal discs, ligaments, tendons, and muscles in the neck and back that has caused pain.
The injury image may confirm critical information like the angle of impact between the vehicles. We consult with your orthopedic or neurosurgeon about whether your injuries are consistent with a head-on, t-bone, rear-end, or other point of impact.
The primary purpose of an MRI is diagnostic. Based upon your MRI results, your doctor can prescribe the right treatment and give you a more accurate prognosis of recovery. I will later use this information to calculate your damages, including the medical care you need now and in the future.
An MRI can detect injuries that aren’t outwardly visible and are often heavily scrutinized by insurance companies. A broken leg can be seen and a sprained ankle produces obvious swelling, bruising, and redness. There isn’t much question that you are in pain and can’t walk without aid.
But what about a herniated disc? You may look perfectly fine but be in excruciating pain and unable to sit or stand. The MRI image is much more powerful evidence of your pain and mobility restrictions than your testimony alone.
We are able to use the MRI to more accurately prove the extent of your damages and help our clients recover a higher settlement or jury verdict.