- Order an x-ray
You will never be criticised for ordering an x-ray. They show us a lot of information: for example an x-ray is a better test than MRI for looking for arthritis.
- Make it the right one, and make it a good one
Ensure that it is correct and of decent quality – patients frequently need repeat x-rays if they are poorly done.
- Knee: Knee AP WB, lat, patella (WB = weight bearing). Make sure you stipulate patella, because otherwise it will not be done. The patella is a third of the joint
- Hip: AP pelvis, AP/lat hip.
- Know when to order an MRI
Magnetic Resonance Imaging is useful in both hips and knees, looking for soft tissue disorders. MRI scans are of little use in arthritis, including meniscal tears, labral tears and chondral injuries.
Not everyone undergoing surgery needs to have an MRI. Although they are almost becoming expected, they can delay surgery and are very expensive. MRI quality and the report quality varies significantly from place to place so if in doubt leave it for Dr Walker to order. Occasionally he may send the patient for a repeat scan if the quality is not acceptable.
- Bone scans can help to localise pain
They are usually ordered by Dr Walker.
- CT scans are helpful in trauma and special circumstances only
Computerised Tomography scans are usually ordered by Dr Walker. Generally CT scans are used to look for fractures or specific anatomic variants.
- There is limited use for Ultrasound
Ultrasounds cost patients time and money and are not often very helpful.