Shoulder pain is extremely common, yet can be debilitating. Magnetic resonance imaging (MRI) has been the imaging modality of choice to figure out what’s contributing to someone’s shoulder pain. However, MRI scans are costly. Westermann et al (Clin Orthop Relat Res, 2017) published that the average cost of a shoulder MRI was $1874 - note that the true patient cost was less than this due to insurance discounts but still well over $1000. This is a very large out of pocket expense for those with high deductible health plans.
Diagnostic ultrasound is a significantly cheaper alternative.
Highly trained sports medicine and musculoskeletal physicians can utilize diagnostic ultrasounds to provide quick and accurate diagnoses. Ultrasounds are done in the office and at a fraction of the cost of an MRI. For reference, the cost of a diagnostic ultrasound (CPT codes 76881 or 76882) costs anywhere between $60-$100.
Levine et al. (Curr Sports Med Rep, 9/2012) summarized that “ultrasound findings for rotator cuff tears compared with surgical findings.” Meaning, what a physician saw on a diagnostic ultrasound scan correlated with what was seen in the operating room. Several studies have shown that ultrasounds have a diagnostic efficacy for full thickness rotator cuff tears up to 96% and for partial thickness tears up to 94%. This was equivalent with MRI accuracies for full thickness rotator cuff tears up to 97% and partial thickness tears up to 92%.
Levine goes on to break down the advantages of ultrasound compared with MRI:
Both are excellent options to look at the shoulder soft tissue and rotator cuff.
Ultrasound is better for foreign bodies, soft tissues around hardware, dynamic imaging, and guided procedures.
MRI is better for the labrum, articular cartilage, bone marrow, and deep soft tissues.
Diagnostic musculoskeletal ultrasound is the foundation of my sports medicine practice. My patients do not need to wait for MRI authorizations. They do not need to wait to schedule an appointment with radiology. They do not have a huge out of pocket cost associated with shoulder MRIs.
My patients come into the office and leave with a diagnosis that same visit. They love that they can “see” into their shoulder in real time. They can tell me exactly where their pain is and I can ultrasound that area and show them why they have pain there. In my opinion, diagnostic musculoskeletal ultrasound provides more patient satisfaction, equally accurate diagnoses, and is significantly cheaper for patients.