Primary care referral criteria for musculoskeletal MRI scans

Transcription

1 Appendix 1 Information from Princess Alexandra Hospital Primary care referral criteria for musculoskeletal MRI scans Accepted Criteria for Direct Access MRI Body Part Symptoms Imaging indicated Lumbar Spine Low Back Pain with adverse symptoms or signs Thoracic Spine Acute Cauda Equina. Sphincter disturbance Saddle anesthesia Thoracic pain with radicular radiation - long tract signs or persistent symptoms. Urgent MRI spine indicated. Urgent specialist referral may be appropriate. Complex or urgent cases can be discussed with a Radiologist *. Gait disturbance Severe progressive motor loss Widespread neurological deficit Previous carcinoma Systemically unwell/weight loss HIV, IV drug abuse Steroids Structural deformity Urgent referral via A+E or Neurosurgery route. Urgent MRI indicated. MRI Indicated. If long tract signs are present, an urgent MRI is indicated. In adults, thoracic radicular pain may be an early sign of impending cord compression. Knee Acute Knee Pain Following trauma or accident, in previously non-symptomatic joint, if symptomatic after 6 weeks first. MRI Knee Indicated if no bony cause found, especially under the age of 60 and without signs of osteoarthritis.

2 Ankle and Foot Chronic ankle or foot pain Plain radiographs initially for ankle or foot pain. MRI for non-acute conditions only on specialist advice *. Acute ankle or foot pain following trauma. Plain radiographs initially to exclude bony injury. MRI can be considered for symptoms not resolving following conservative management where bony injury has been excluded. Achilles tendonopathy, fibromatosis, Morton's neuroma, non-radiopaque foreign body, ganglion. Consider ultrasound. Shoulder Elbow Wrist Pain and/or restricted movement Pain and/or restricted movement Plain radiographs first to evaluate joint degeneration or bony abnormalities. Consider ultrasound for pain, restricted movement, rotator cuff tears, tendonopathy, ACJ abnormalities. MRI on specialist advice only *. Ultrasound can be considered for evaluation of tennis elbow, tenosynovitis, biceps tendon pathology or any soft tissue lumps. MRI on specialist advice only- usually reserved when surgical intervention is being considered. Soft tissue lumps, ganglia, Ultrasound is the modality of choice to evaluate tenosynovitis or non-radiopaque soft tissue lumps, ganglia, tenosynovitis or nonradiopaque foreign body. foreign body (no history of trauma). MRI on specialist advice only- usually reserved when surgical intervention is being considered. * If you require advice or wish to discuss any complex/urgent cases please contact the Consultant Radiologist covering the hot desk at Princess Alexandra Hospital. Telephone = ext This service is available Monday-Friday during the following hours; 10am-1pm 3pm-5pm

3 Criteria No Longer Accepted: Body Part Symptoms Imaging indicated Lumbar Spine Thoracic Spine Sciatica less than 6 weeks with MRI not usually indicated. no adverse features. RCGP guidelines indicate that conservative (no red flag symptoms or signs) management is appropriate in sciatica with out adverse features, MRI reserved for sciatica which does not resolve within the 6 week period. Sciatica symptoms for more than 6 weeks that have failed to improve with conservative management Mid line chronic low back pain without progression Chronic facet joint symptoms and signs but without radiation down leg Repeat MRI scans for similar symptoms. Isolated Chronic Back Pain - Without adverse features or radiation MRI indicated on a routine basis. Clinical radiological correlation is important, as a significant of disc herniations demonstrated on MRI are asymptomatic. In the absence of focal or neurological signs, asymptomatic chronic degenerative changes are a common finding. A trial of non interventional treatment ( exercise, physiotherapy, chiropractor treatment may be appropriate) Non-invasive treatment is often effective. MRI should be reserved for cases unresponsive to conservative management or with atypical symptoms. Please do not rescan patients within two years unless there are new adverse symptoms or signs. However, if surgical intervention is being considered a recent scan may be required but usually at the request of the specialist.. MRI very rarely identifies treatable lesions in the absence of focal features. Imaging is rarely useful in the absence of neurological signs or pointers of metastases or infection

4 Acute thoracic pain in elderly patients, or those with a history of malignancy. Cervical Spine Neck pain with brachalgia and/or neurological signs. Not settling with self-management. These cases may require more urgent referral for imaging to assess for vertebral collapse. In these cases Plain radiographs are often adequate with MRI reserved for complex cases. Please contact Radiology if you require advice from a Radiologist. * MRI Cervical spine Indicated. If long tract signs are present, an urgent MRI is indicated. Consider referral to CRS stating clear symptoms. CRS may then refer for DA MRI if there are single route symptoms. In patients where pain affects lifestyle, and conservative treatment has not helped, or there are adverse features (e.g. long tract signs) MRI is most useful where there are single root symptoms and signs, and least useful where symptoms and signs are referable to multiple dermatomes. Acute Neck pain Chronic Neck Pain Severe or adverse features only. Most neck pain resolves on conservative treatment. Degenerative changes are invariably seen on MRI beginning early middle age and are often unrelated to symptoms. Degenerative changes are invariably seen on MRI beginning early middle age and are often unrelated to symptoms. Hip Soft tissue swelling/lump, hip effusion, hernia. Hip Pain Consider ultrasound. first. Further imaging only on specialist advice *. Consider specialist referral if complex history. Knee Bakers Cyst Consider ultrasound for confirmation of Baker's cyst, ONLY IF diagnosis is in doubt.

5 Long-Standing Knee Pain (18-60 Year Old) Long-Standing Knee Pain (Over 60 years Old) first to exclude premature OA, any bony cause (OCD / loose bodies). Can proceed to MRI, if the above are excluded, and if meniscal or other soft tissue pathology suspected. Consider specialist referral if complex history. Plain radiographs only, in view of high likelihood of joint degeneration. MRI only on specialist advice *.