Rotator cuff tear: take your surgeon’s word that you need an MRI

SAN FRANCISCO — An insurance company’s policy of refusing to approve an MRI scan to diagnose a rotator cuff tear until the patient has first attempted physical therapy will likely not only increase overall medical costs but also result in inconvenience to the patient. A single-center study showed that it may provide a necessary burden.

Of the 365 patients who underwent MRI scans after their initial orthopedic surgeon visit, 43% were found to have full-thickness tears, and an additional 25% had partial tears, said Caroline Gutowski, BS, of Rowan University’s Cooper School of Medicine in Camden. It is said that there was. New Jersey.

The diagnostic yield of MRI is essentially the same whether the patient has already tried conservative treatments such as physical therapy or steroid injections, he told attendees here at the American Academy of Orthopedic Surgeons’ annual meeting. told. In patients previously treated conservatively, 68% were found to have complete or partial rupture, compared with 67% in patients without prior treatment.

Gutowski noted that a standard six-week course of twice-weekly physical therapy within the Cooper system costs $2,328, while an MRI costs $2,268. Therefore, his two-thirds of patients who initially tried conservative treatment but needed imaging tests to understand their condition essentially cost him twice as much.

The results provided “expert validation of clinical suspicions.” [rotator cuff] “The first test brought me to tears,” she said. “Decisions about physical therapy or timely imaging may be best left to professional clinicians rather than insurance companies.”

Insurance companies’ policies regarding advanced image processing did not emerge out of thin air. Many studies have shown that such imaging is overused for conditions such as low back pain. However, step-based approaches and requirements for prior authorization have become more inflexible, raising other forms of clinical suspicion. It’s the clinician’s belief that insurance companies are more concerned about cost-cutting than the health of their customers.

Gutowski noted that if an MRI scan is truly warranted, prior authorization would “delay intervention, prolong patient discomfort, and increase healthcare costs.”

For this study, she and colleagues reviewed the records of 365 Cooper patients who underwent MRI scans to evaluate for suspected rotator cuff tears. Just under half of this group had previously received steroid injections or physical therapy. The mean age was approximately 60 years, slightly younger in those with no tears and slightly higher in those with full-thickness tears.

Not all patients with complete rupture underwent surgery, approximately 44%. Gutowski did not report how these patients were ultimately treated or whether they were as satisfied with the results as those who underwent surgical repair. However, demographics and insurance status were similar between those who underwent surgery and those who did not.

Limitations of this study include its single-center design and lack of details regarding the specific physical therapy some patients received. The latter meant the researchers could not determine the prevalence of rotator cuff tears in patients who received the full six-week course typically required by insurance companies.

“Future research is needed to clarify postoperative outcomes between patients who received MRI preapproval and those who received the mandated six weeks of physical therapy,” Gutowski said. Stated.