دورية أكاديمية
Accuracy of Clinical Suspicion for Rotator Cuff Tears by Orthopedic Surgeons When MRI Was Ordered on Initial Visits: Should Physical Therapy Be Mandated by Insurance Before MRI?
| العنوان: | Accuracy of Clinical Suspicion for Rotator Cuff Tears by Orthopedic Surgeons When MRI Was Ordered on Initial Visits: Should Physical Therapy Be Mandated by Insurance Before MRI? |
|---|---|
| المؤلفون: | Gutowski CT; Medicine, Cooper Medical School of Rowan University, Camden, USA., Pohl N; Medicine, Cooper Medical School of Rowan University, Camden, USA., Stern M; Medicine, Cooper Medical School of Rowan University, Camden, USA., Gentile PM; Orthopaedic Surgery, Cooper University Health Care, Camden, USA., Rivera-Pintado C; Orthopaedic Surgery, Cooper University Hospital, Camden, USA., Johnsen PH; Orthopaedic Surgery, Cooper University Hospital, Camden, USA., Hunter K; Biostatistics, Cooper University Hospital, Camden, USA., Fedorka C; Orthopaedic Surgery, Cooper University Hospital, Camden, USA. |
| المصدر: | Cureus [Cureus] 2024 Jun 10; Vol. 16 (6), pp. e62079. Date of Electronic Publication: 2024 Jun 10 (Print Publication: 2024). |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Cureus, Inc Country of Publication: United States NLM ID: 101596737 Publication Model: eCollection Cited Medium: Print ISSN: 2168-8184 (Print) Linking ISSN: 21688184 NLM ISO Abbreviation: Cureus Subsets: PubMed not MEDLINE |
| أسماء مطبوعة: | Original Publication: Palo Alto, CA : Cureus, Inc. |
| مستخلص: | Introduction: Insurance companies often mandate six weeks of physical therapy (PT) prior to approving MRIs for patients with atraumatic rotator cuff (RTC) tears. While this is designed to limit unnecessary imaging orders, it can increase healthcare costs and delay diagnosis and surgery. This study investigated the incidence of full- and partial-thickness tears when an MRI was ordered at the time of initial consultation for shoulder pain by an orthopedic provider. Methods: A retrospective review of patients who had an MRI ordered upon initial orthopedic consultation for chronic shoulder pain was conducted. The primary outcome measured was the presence of RTC tears as determined by the MRI report. The cost of six weeks of PT versus the cost of immediate MRI in these patients was collected from our institution's financial database. ANOVA, independent T-test, and chi-square test were used to analyze the differences between groups. Results: A total of 365 patients were included. There were no significant differences in demographics between patients with full, partial, or no tears, with the exception that patients with full-thickness tears were older. Specifically, 43.0% had a full-thickness tear, 24.7% had a partial-thickness tear, and 32.2% had no tear on MRI. A total of 56.1% of the full-thickness tears proceeded to surgery. The cost of an upper extremity MRI without contrast averages $2,268, while two sessions of PT per week for six weeks totals $2,328. Discussion: Over 67% of MRI orders yielded a positive finding of an RTC tear and remained at 67.2% in the absence of a history of conservative treatment, validating a specialist's clinical suspicion for an RTC tear and indication for MRI. Pre-MRI PT to satisfy insurance requirements may therefore delay intervention and increase healthcare costs when an orthopedic provider believes an MRI is warranted for clinical decision-making. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Cooper Health System issued approval #22-040. The IRB has determined that this study is exempt, according to the criteria at 45 CFR 46.104. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Dr. Catherine Fedorka declare(s) personal fees from Stryker Corporation. Dr. Fedorka is a paid consultant for Stryker Corporation. The other authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Gutowski et al.) |
| References: | J Am Board Fam Med. 2013 Jan-Feb;26(1):93-5. (PMID: 23288287) Health Aff (Millwood). 2012 Dec;31(12):2830. (PMID: 23213169) Am Soc Clin Oncol Educ Book. 2023 May;43:e100036. (PMID: 37220314) Sports Med Arthrosc Rev. 2018 Sep;26(3):e10-e22. (PMID: 30059442) Health Aff (Millwood). 2009 Jul-Aug;28(4):w533-43. (PMID: 19443477) Am J Phys Med Rehabil. 2017 Mar;96(3):176-183. (PMID: 27386812) J Bone Joint Surg Br. 2010 Jan;92(1):83-91. (PMID: 20044684) J Man Manip Ther. 2013 Aug;21(3):148-59. (PMID: 24421626) Am J Sports Med. 2023 Apr;51(5):1328-1339. (PMID: 35099309) J Bone Joint Surg Am. 2012 Feb 1;94(3):227-33. (PMID: 22298054) J Bone Joint Surg Am. 2013 Nov 20;95(22):1993-2000. (PMID: 24257656) Am Fam Physician. 2011 Apr 15;83(8):883-4. (PMID: 21524028) AJR Am J Roentgenol. 2021 Dec;217(6):1390-1400. (PMID: 34161130) Orthop J Sports Med. 2020 Jul 24;8(7):2325967120937016. (PMID: 32782903) J Am Acad Orthop Surg. 2021 Dec 15;29(24):1031-1043. (PMID: 34520444) J Bone Joint Surg Am. 2019 Oct 2;101(19):1775-1782. (PMID: 31577683) J Spine Surg. 2023 Jun 30;9(2):114-116. (PMID: 37435325) Medicine (Baltimore). 2020 Mar;99(12):e19579. (PMID: 32195972) Ann Palliat Med. 2021 Feb;10(2):2293-2303. (PMID: 33549026) Clin Orthop Relat Res. 2007 Feb;455:52-63. (PMID: 17179786) J Am Acad Dermatol. 2024 Apr;90(4):877-878. (PMID: 36822353) World J Orthop. 2015 Dec 18;6(11):902-18. (PMID: 26716086) Clin Spine Surg. 2023 Jun 1;36(5):186-189. (PMID: 36728293) Health Aff (Millwood). 2012 Aug;31(8):1876-84. (PMID: 22842655) N Engl J Med. 2023 Mar 9;388(10):867-870. (PMID: 36876754) Gynecol Oncol Rep. 2023 Mar 11;46:101159. (PMID: 36942280) Curr Sports Med Rep. 2014 Sep-Oct;13(5):307-13. (PMID: 25211618) J Bone Joint Surg Am. 2019 Jun 19;101(12):1050-1060. (PMID: 31220021) J Shoulder Elbow Surg. 2016 Dec;25(12):e378-e385. (PMID: 27496352) J Orthop Sports Phys Ther. 2020 Mar;50(3):131-141. (PMID: 31726927) |
| فهرسة مساهمة: | Keywords: atraumatic rotator cuff tears; healthcare costs; insurance; magnetic resonance imaging; physical therapy; rotator cuff repair |
| تواريخ الأحداث: | Date Created: 20240711 Latest Revision: 20240712 |
| رمز التحديث: | 20240712 |
| مُعرف محوري في PubMed: | PMC11235402 |
| DOI: | 10.7759/cureus.62079 |
| PMID: | 38989344 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder كن أول من يترك تعليقا!