Treat the patient not the MRI

While teaching a medical student today I had the opportunity to demonstrate how one should never treat findings noted on investigations such as radiographs (x-rays), ultrasound or MRI unless they correspond with the patient’s history and clinical findings.

A patient referred for a meniscal tear of the knee confirmed by MRI with the request to help manage their knee pain until the surgeon could see her in 5 months. As required we ¬†took a detailed history and performed a comprehensive physical exam. The patient had significant tightness of the soft tissues around the knee cap causing restricted knee flexion range which could mimic a meniscal tear. Standard tests for meniscal tearing were negative. After performing some techniques used by physiotherapists to release the tight knee cap the patient had much less pain with walking and could flex the knee to a greater extend and with less pain. This patient benefited greatly from a sports medicine consultation and has been directed to have physiotherapy for the knee. I suggested that the surgeon’s appointment be kept for now but most likely will not be needed.

The patient was very happy and the medical student learned a great lesson.