Table 7 Overview of low-value imaging in upper and lower limbs
From: Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review
Type of imaging | Reason for examination | Outcome | Suggested practice by included study/studies | References |
|---|---|---|---|---|
Shoulder MRI | Shoulder pain | 20% relevant findings other imaging modalities could not find | Use XR and US instead | |
Rotator cuff tear | 9.8% change in management | Â | [159] | |
Routine shoulder XR | Frozen shoulder | 2.3% relevant findings | XR if positive physical examination only | [161] |
Atraumatic shoulder pain | 14.9% change in diagnosis 1.7% change in management | Â | [160] | |
Post-op shoulder XR | Primary anatomic total shoulder arthroplasty | 0–5% relevant findings No change in management |  | [163] |
Post-op humerus XR | Supracondylar humerus fracture | Do not change patient management | XR only unstable fractures | [162] |
Wrist MRI | Wrist ligamentous injury | 28% change in management | Â | [170] |
Follow-up wrist XR | Uncomplicated distal radius fracture | Do not change patient management | Â | [164] |
Distal radius fracture Fixation with a Volar Locking Plate | 0–4% change in patient management |  | [165] [166] | |
Distal radius fracture | Do not change patient management | Â | [167] | |
Upper extremity MRI | Work related complaints | No change in management | Â | [173] |
Knee MRI | Knee pain |  < 1% change in treatment | Use XR first MRI if locking or surgical history or conservative treatment fails | |
Post-op knee XR | Anterior cruciate ligament reconstruction | Do not change patient management | Â | [151] |
Partial knee arthroplasty | No change in management | Â | ||
Primary total knee replacement | Do not change patient management | Â | [156] | |
Medial patellofemoral ligament reconstruction | Do not change patient management | Use intra operative fluoroscopy | [152] | |
Knee/foot XR of adjacent joints | Ankle fracture | Do not change patient management | Use XR if clinical suspicion of fracture near adjacent joints | [150] |
Ankle MRI | Acute Achilles Tendon Ruptures | Imaging generally not indicated in guidelines | Use MRI if equivocal examination findings | [149] |
Lower limb imaging | Lower extremity stress fractures | Low diagnostic accuracy of CT, XR, US, and scintigraphy | Use MRI as it has the highest sensitivity and specificity | [148] |
Post-op lower limb XR | Tibia plateau fixation | 0.7% change in patient management | Â | [153] |
XR, CT, MRI, bone scans, FDG-PET | Musculoskeletal Tumors | Do not change patient management | Refer patient to specialist at an early stage | [174] |
Post splinting skeletal XR | Fractures | Do not change patient management | Use XR only in displaced fractures manipulated during splinting | [169] |
Post-op CT of joints | Peri-articular fractures |  < 5% change in management |  | [171] |
CT of joints | Orthopedic trauma (spine, pelvis, lower extremities) | 25.3% relevant findings | Â | [168] |
Musculoskeletal MRI | Long bone cartilaginous lesions | Advanced imaging was used too often | Refer patients to specialist at an early stage | [172] |