Pain medial knee negative MRI



by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit




Magnetic resonance imaging (MRI) uses a magnetic field to generate vibration of water molecules in tissue to produce images.

Since different body tissues have different water content, the images obtained will allow the diagnostician to identify abnormalities.

The knee is one of the most “MRI’d” joints. When patients present with knee pain, any number of problems may be happening. In the medial knee (the inner part), the areas of concern include the medial collateral ligament, the medial meniscus, the medial femoral condyle (the lower end of the upper leg bone), and several small bursae or tendons.

MRI is not 100% sensitive (meaning it picks up all abnormalities) nor is it 100% specific (meaning what it picks up is what the problem is).

Therefore, it is possible to have a negative MRI and still have significant injury or damage to the areas mentioned above.

Medial meniscal tears can be missed.

Anserine bursitis can cause medial knee pain and is not always picked up on MRI.

In particular, significant amounts of osteoarthritis or inflamed synovium (lining of the joint capsule) may be present and not seen on MRI scanning. Another problem is osteonecrosis. This is a condition where a small section of bone (usually on the medial

femoral condyle) dies from lack of blood supply. The overlying cartilage then becomes loose and detaches. This is not always readily visible on MRI scanning.

Bone bruises also are not always picked up on MRI.

Another important consideration in evaluating MRI interpretation is the strength of the scanner and the skill of the person reading the scan.

Administration of contrast material such as gadolinium can help improve sensitivity and specificity.

The use of different techniques to enhance contrast between tissue is also recommended.

Finally, a review of the patient’s symptoms and signs is mandatory. Is the problem really in the knee or does it originate elsewhere? For example, hip pathology and low back abnormalities can lead to referred pain in the knee. Careful attention to these areas may help avoid a potentially serious error in diagnosis.

In patients with ongoing true medial knee pain with negative MRI exams, an arthroscopy may be warranted.





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