Lawyer Monthly - January 2022 Edition

an you give a brief overview of MRI scans and how they work? MRI scans are a high-level imaging modality that uses magnets to allow detailed pictures of human anatomy. In orthopaedics, MRI scans are best for imaging soft tissues such as muscles, tendons and ligaments. It can also help differentiate between water, fat and solids, which can be important in the evaluation of tumours and infections. In what sort of cases are MRI scans particularly relevant? MRI scans are relevant in all cases involving orthopaedic injuries – so much so they are often ordered when not needed. For example, in my specialty we need MRI to detect rotator cuff tears, ACL tears and labrum tears. These structures are not visible on x-ray. How often do you encounter MRI imaging C The Challenges of Using MRI Imaging as Evidence While a useful tool, MRI imaging is not a perfect technology. This is particularly relevant in personal injury lawsuits, where inaccurate MRI findings can significantly influence a patient’s actions. Jonathan Hersch MD, a qualified orthopaedic surgeon, expands below on how overreliance on MRI imaging can be counterproductive for counsel and how it can best be avoided. 74 WWW.LAWYER-MONTHLY.COM | JAN 2022 EXPERT WITNESS as part of your work as an expert witness? Every case I review as an expert witness has at least one MRI to review if not more. It has become the standard of care for most soft tissue injuries. What issues do you typically see regarding this technology and its use in legal cases? The real problem with MRI is the high prevalence of “abnormal findings” on MRI that are a “normal” part of the ageing process and not necessarily the source of a patient’s pain. For example, a 60-year-old patient who has a slip and fall gets an MRI of the knee. It will show a meniscus tear over 25% of the time in someone of that age even if they do not have symptoms. Similar goes for rotator tears in the shoulder and lumbar herniated discs. Proving that the MRI findings in a particular patient have anything to do with their complaints is very challenging. How have you overcome these obstacles when they have arisen? When faced with abnormal findings on MRI I pay close attention to the mechanism of injury – what actually happened to the patient. Then I ask if it is reasonable that this injury could have caused the “tear” seen on MRI or if it was more likely a pre-existing problem. I also look closely at recorded examinations and the patient’s complaints. Do they all add up to the MRI findings or is there a different explanation? I always ask to see the MRI scans myself. Are there alternative methods to MRI imaging that are less problematic? MRI certainly gives us the best image quality to see structures of anatomy. But other modalities can be done as well Proving that the MRI findings in a particular patient have anything to do with their complaints is very challenging. Jonathan Hersch, MD Orthopaedic Surgeon – Sports Medicine and Arthroscopic Surgey 9970 Central Park Blvd, N Suite 400-A, Boca Raton, FL 33428, US Tel: +1 561-430-4610 E: jhersch1@gmail.com facebook.com/#! JonathanHerschmd twitter.com/HerschMD linkedin.com/in/HerschMD/