Improving Effective Magnetic Resonance Imaging (MRI) Application in Soft Tissue Wrist Injury

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Figure 1.
Flowchart of Cohort Selection. MRI, magnetic resonance imaging.

Table 1.

Baseline Demographics of Patients

	All Patients		Impact MRI Group		Non-Impact MRI Group		P-Value
Number of patients	140		39	28%	101	72%
Age	37		33	(30–37)^*	39	(36–41)^*	.01^{^†^‡}
Gender
Male	53	38%	14		39		.85^{^§}
Female	87	62%	25		62
BMI	28.2		28.2		27.8		.86^{^†}
Obesity	48	34%	13	33%	35	35%	1.00^{^§}
Smokers	21	15%	7	18%	14	14%	.60^{^§}
Referring provider
UMHS	122	87%	33	85%	99	88%	.56^{^§}
Non-UMHS	18	13%	6	15%	12	12%	.56^{^§}
Previous hand surgery/trauma	41	29%	10	26%	31	31%	.68^{^§}
Charlson Comorbidity Index	0.31		0.18		0.36		.15^{^§}
Prior therapy/splinting/injections	87	62%	21	54%	66	65%	.25^{^§}
Insured in healthcare	133	95%	37	95%	96	95%	1.00^{^§}
MRI timing (<6 weeks of symptoms)	48	34%	19	49%	29	29%	.03^*^{^§}

BMI, body mass index; MRI, magnetic resonance imaging; UMHS, University of Michigan Health System.
↵* 95% confidence interval (CI).
↵† Student t-test.
↵‡ Statistical significance.
↵§ Fisher exact test.

Table 2.

Comparison of Impact vs Nonimpact MRI

Variable	Impact MRI		Nonimpact MRI		P-Values
Total patients	39	28%	101	72%
Ordering physician
Hand surgeon	26	67%	40	40%	.0048^*^{^†}
Referring physician	13	33%	61	60%	.0048^*^{^†}
Study indication
Wrist pain	11	28%	60	64%	.0012^*^{^†}
Question of specific injury	28	72%	41	36%	.0012^*^{^†}
DRUJ stability	2		1
Scapholunate injury	17		7
TFCC injury	3		12
Other ligamentous injury	6		21

DRUJ, distal radioulnar joint; MRI, magnetic resonance imaging; TFCC, triangular fibrocartilage complex.
↵* Fisher exact test.
↵† Statistical significance.

Table 3.

Baseline Demographics Comparison between Hand Surgeon and Referring Physician Patient Cohorts

	Hand Surgeon Group		Referring Physician Group		P-Value
Number of patients	66		74
Age	36		38		.15^*
Gender
Male	22	33%	31	42%	.39^{^†}
Female	44	67%	43	58%
BMI	28.8		27.9		.47^*
Obesity	24	36%	24	32%	.60^{^†}
Smokers	9	14%	12	16%	.81^{^†}
Referring provider
UMHS	112	85%	66	89%	.61^{^†}
Non-UMHS	10	15%	8	11%	.61^{^†}
Previous hand surgery/trauma	27	41%	14	19%	.005^{^†^‡}
Charlson Comorbidity Index	0.24		0.36		.24^*
Prior therapy/splinting/injections	44	67%	43	58%	.38^{^†}
Insured in healthcare	62	94%	71	96%	.71^{^†}
MRI timing (<6weeks of symptoms)	27	41%	21	28%	.15^{^†}

BMI, body mass index; MRI, magnetic resonance imaging; UMHS, University of Michigan Health System.
↵* Student t-test.
↵† Fisher exact test.
↵‡ Statistical significance.

Table 4.

Comparison of MRI Indications Ordered by Hand Surgeons and Referring Physicians

Variables	Hand Surgeon MRI		Referring Physician MRI		P-Values
Total patients	66	47%	74	53%
Study indication
Wrist pain	23	35%	48	65%	.0006^*^{^†}
Question of specific injury	43	65%	26	35%	.0006^*^{^†}
DRUJ stability	3		0
Scapholunate injury	20		4
TFCC injury	7		8
Other ligamentous injury	13		14

DRUJ, distal radioulnar joint; MRI, magnetic resonance imaging; TFCC, triangular fibrocartilage complex.
↵* Statistical significance.
↵† Fisher exact test.

Table 5.

Pre-MRI to Post-MRI Recommendation Changes in Impact and Non-Impact MRI Studies

Pre/Post MRI Recommendations	All Patients	Hand Surgeon Cohort Patients		Referring Physician Cohort Patients		P-Values
Impact MRI	39	26		13
Non-op → Op	10	4	15%	6	46%	.056^*
Op → Non-op	0	0	0%	0	0%	1.00
Eq → Non-op	19	15	58%	4	31%	.18
Eq → Op	10	7	27%	3	23%	1.00
Op → Eq	0	0	0%	0	0%	1.00
Non-op → Eq	0	0	0%	0	0%	1.00
Nonimpact MRI	101	40		61
Non-op → Non-op	75	20	50%	55	90%	<.001^*
Op → Op	21	16	40%	5	8%	.20
Eq → Eq	5	4	10%	1	2%	.08

Eq, equivocal; MRI, magnetic resonance imaging; Non-op, non-operative; Op, operative.
↵* Statistical significance.

Table 6.

Multivariate Regression of Predictive Factors to Impact MRI

	Adjusted OR	95% CI	P-Values
Age	0.97	(0.93–1.00)	.067
MRI Timing (<6 weeks of symptoms)	2.59	(1.12–5.99)	.026^*
Study indication: No specific diagnosis	0.39	(0.16–0.94)	.036^*
Referring physician	0.43	(0.18–1.00)	.052^*

Appendix

ICD-9 Code	Description
719.43 to 719.44	Wrist pain
728.4	Laxity of ligament
833.01	DRUJ Instability (closed)
833.11	DRUJ Instability (open)
842.00	Sprain of wrist, unspecified site
842.01	Sprains and strains wrist and hand; wrist; carpal (joint)
842.02	Sprain of radiocarpal (ligament) of wrist
842.09	Sprains and strains of wrist and hand; distal radioulnar joint
905.7	Late effect of sprain and strain without mention of tendon injury
959.3	Other and unspecified injury to elbow forearm and wrist