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Updated: Jul 30, 2025
Quantitative Magnetic Resonance Imaging of Skeletal Muscle Disease
Published on: December 18, 2016
The Use and Downstream Associations of Magnetic Resonance Imaging for Lateral Epicondylitis
Lauren M Shapiro1, Jessica M Welch2, Thompson Zhuang3
1Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, CA.
Purpose:
Low-value imaging is associated with wasteful health care spending and patient harm. The routine use of magnetic resonance imaging (MRI) for the work-up of lateral epicondylitis is an example of low-value imaging. As such, our aim was to investigate the use of MRIs ordered for lateral epicondylitis, the characteristics of those undergoing an MRI, and the downstream associations of MRI with other care.
Methods:
We identified patients aged ≥18 years with a diagnosis of lateral epicondylitis between 2010 and 2019 using a Humana claims database. We identified patients with a Current Procedural Terminology code corresponding to an elbow MRI. We analyzed the use and downstream treatment cascades in those undergoing MRI. Multivariable logistic regression models were used to assess the odds of undergoing an MRI, adjusting for age, sex, insurance type, and comorbidity index. Separate multivariable logistic regression analyses were used to determine the association between undergoing an MRI and the incidence of secondary outcomes (eg, receiving surgery).
Results:
A total of 624,102 patients met the inclusion criteria. Of 8,209 (1.3%) patients undergoing MRI, 3,584 (44%) underwent it within 90 days after diagnosis. There was notable regional variation in MRI use. The MRIs were ordered most frequently by primary care specialties and for younger, female, commercially insured, and patients with more comorbidities. Performance of an MRI was associated with an increase in downstream treatments, including surgery (odds ratio [OR], 9.58 [9.12-10.07]), injection (OR, 2.90 [2.77-3.04]), therapy (OR, 1.81 [1.72-1.91]), and cost ($134 per patient).
Conclusions:
Although there is variation in the use of MRI for lateral epicondylitis and its use is associated with downstream effects, the routine use of MRI for the diagnosis of lateral epicondylitis is low.
Clinical Relevance:
The routine use of MRI for lateral epicondylitis is low. Understanding interventions to minimize such low-value care in lateral epicondylitis can be used to inform improvement efforts to minimize low-value care for other conditions.
Insights
Routine magnetic resonance imaging (MRI) for lateral epicondylitis is low, despite associations with increased downstream treatments and costs. Minimizing this low-value care can inform broader healthcare improvements.
Area of Science:
- Orthopedic imaging utilization
- Health economics and outcomes research
- Value-based healthcare
Background:
- Low-value imaging contributes to healthcare waste and patient harm.
- Routine magnetic resonance imaging (MRI) for lateral epicondylitis is a potential area of overuse.
- Investigating MRI use patterns and downstream effects is crucial for optimizing care.
Purpose of the Study:
- To examine the utilization of MRIs for lateral epicondylitis.
- To identify patient characteristics associated with MRI ordering.
- To analyze the downstream treatment and cost implications of MRI use.
Main Methods:
- Analysis of a large claims database (Humana) from 2010-2019 for patients diagnosed with lateral epicondylitis.
- Identification of patients who underwent elbow MRI using Current Procedural Terminology codes.
- Multivariable logistic regression to assess factors influencing MRI use and its association with subsequent treatments (surgery, injections, therapy) and costs.
Main Results:
- 1.3% of 624,102 patients with lateral epicondylitis underwent MRI, with 44% within 90 days of diagnosis.
- MRI use showed regional variation and was more common in younger, female, commercially insured patients with higher comorbidity scores.
- MRI was associated with significantly increased odds of surgery (OR 9.58), injections (OR 2.90), therapy (OR 1.81), and an additional $134 in cost per patient.
Conclusions:
- The routine use of MRI for lateral epicondylitis diagnosis is infrequent.
- MRI utilization is linked to increased downstream interventions and healthcare costs.
- Findings highlight opportunities to reduce low-value care in lateral epicondylitis and inform strategies for other conditions.
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