Ask Dr. Geier – MRIs for knee pain

Hey everyone! It’s time for another Ask Dr. Geier column. I realize that these are among the most popular of all the posts I write. To answer as many questions from all of you that I receive, I answer between three to seven of them each week on The Dr. David Geier Show. Please check it out, and consider subscribing on iTunes!

In this column I answer a question that I receive often in my practice, especially with baby boomers trying to stay active. As always, please refer to my disclaimer. I cannot offer specific medical advice on this blog, show, by email, or in social media. Please consult your doctor for specific clinical questions.

Thanks for reading!

David

Connie Wilson in Norman, Oklahoma:

I am having an MRI tomorrow on my knee. I had an X-ray the other day, and all it showed was arthritis. But the pain I am now having was caused by the simple movement of turning to see where my son was. My knee snapped (not popped), and the pain was extreme. I hobbled back to the car. Just additional information: I have been told I have fibromyalgia, an autoimmune disease, and Non-Hodgkin’s lymphoma. So my question is – should I still have the MRI? I went through 10 days of anti inflammatory without relief.

I cannot address Connie’s situation specifically, as I haven’t examined her or reviewed her x-rays, but I understand this clinical dilemma. I unfortunately see similar presentations frequently.

One major concern after a twisting injury to the knee is a meniscus tear. In young athletes, meniscal tears often require significant trauma. As adults get older, they can often tear a meniscus with seemingly less serious events, such as squatting to pick up an object or turning to change directions.

Arthritis of the knee
Note the fraying of the articular cartilage on the end of the femur.
In many of these patients, pre-existing arthritis is noted in the knee on preliminary x-rays. It is certainly possible that the new twisting event simply flared up the arthritis. On the other hand, it is possible that the motion injured the meniscus between the femur and tibia. An MRI to look for such a tear might be reasonable in several clinical scenarios. For example, if a patient’s pain after one of these events is noticeably different and increased, if the pain localizes to a very specific point on the medial (inside) or lateral (outside) side of the knee, or if the knee is locking or catching, MRI studies can play a diagnostic role.

MRI image of a degenerative medial meniscus tear
MRI image of a degenerative medial meniscus tear
If a degenerative meniscus tear is found in a knee with articular cartilage changes (osteoarthritis), then treatment decisions can be tricky. Please refer to a previous Ask Dr. Geier column I wrote on surgical and nonsurgical options for a degenerative meniscus tear. Please also refer to a three-part series I wrote about the use of x-rays and MRIs for knee problems, as I discuss their use in these situations.

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