Who to believe? MRI or Surgeon?
10 days ago I agreed to have surgical repair of what my orthopedist insisted was a new rupture in the same achilles tendon he repaired 2 months ago. He based the diagnosis on a positive Thompson test (not a twitch) and the word of 2 radiologists who examined an MRI and saw a rupture with gap. Several miserable days passed before the scheduled surgery while I contemplated going back to square one after having already spent 6 weeks NWB and 2 weeks PWB. In recovery I was told that the tendon was not ruptured, no repair was necessary, and that the doc just sewed me back up.
Who do I trust? The surgeon or the radiologists? The surgeon, apparently unable to understand why I am concerned by the second surgery, admitted it could be a tear in the calf muscle, but that he had to open me up to be sure. (!)
Is there anyone out there who has had an incorrect diagnosis of rupture based on a mis-reading of an MRI?
No experience with MRI’s myself but am glad to hear you are OK. What a lot of mixed messages you have been given. Without adding to what you are dealing with it may be worth confirming if the tear was in your calf- I did that a few years back and the recovery was 6 weeks. A PT may be able to diagnose for you (without having to open you up!!!!)
Hi Jennish, sorry to hear about your travails. “The surgeon, apparently unable to understand why I am concerned by the second surgery” <<– my gut response to this is “WTF?!” Meaning: that would be my reaction toward the surgeon if he or she came across to me with that attitude. I would be pretty pissed off. I personally hated surgery and tried to avoid it for the first three weeks after my injury. From my own experience, it was the MRI report that convinced me to go under the knife. But a few weeks later when I was blogging on this site to that effect there were reports by others on the high error rate of using MRIs for trying to get an accurate diagnoses. I am no expert.
This is when you seek out a second opinion. Before going under the knife again with the same surgeon, I would definitely see another orthopedic surgeon. Maybe you need surgery, maybe you don’t. However, your related experience with your current OS just does not sound “right” (IMO). Get a referral to another OS from someone you respect. Good luck! -David
wow, i know how it feels to get a set back but WTF….it might be time to seek a 2nd and 3rd opinion…..good luck
Jennish, I’m sorry for your travails — though if your OS is right, you should recover much quicker from the “exploratory’ surgery than you would starting over.
In my only direct experience with MRIs — 3 scans of my then-93-yr-old Dad’s spine, at 1-month intervals — the information from the MRIs was way worse than useless. Just Plain Wrong, 180 degrees off. All 3 showed a serious spine infection that convinced the MRI folks that Dad needed urgent back surgery. And EACH scan was significantly WORSE than the previous one, reinforcing their view and increasing the urgency. But it was all wrong. By the time we got the results of the third scan, Dad’s backache had gone away, and it never returned for the rest of his life — 5 more years (to 98yo), the last 3 of them free of hospital visits (once we got him out of his house, into a more supportive and social environment)!
My INdirect experience with MRIs is also about spinal MRIs, not AT MRIs, but it reinforces my general skepticism from the above direct experience. E.g., I heard Ontario’s Dr. Hamilton Hall (aka “The Back Doctor”) recommend (several times) that spinal MRIs be reserved for one use only: for your worst enemy! And since then, I’ve heard reports (on Australia’s wonderful The Health Report podcast) of two different studies indicating that spinal MRIs are unreliable enough (especially the high false positive rate) to be worse than useless.
It’s always possible that MRIs of the AT are generally much easier to interpret, or that some MRI practitioners are skilled enough to overcome the failings revealed by these studies. Hard to know.
I think we’ve had a number of people here who have had bad (”positive”?) Thompson tests when we’d expect good ones — maybe mostly non-op patients — and they did come out OK. I don’t really understand what’s going on — though I do know that self-administered Thompson tests (not your case) often give false bad results.