Page 91 - JSOM Summer 2018

When PJs or combat rescue officers complain of pain and dys- 8. Khan HA, Ahad H, Sharma P, et al. Correlation between mag-
function, those complaints are associated with a high rate of netic resonance imaging and arthroscopic findings in the knee
positive findings. This is not surprising, because Operators joint. Trauma Mon. 2015;20(1):e18635.
who go through their selection courses are required to train 9. Hodgson R, O’Connor P, Grainger A. Tendon and ligament imag-
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through pain and not complain. Whether this trait is selected or 10. Roy S. Radiation—friend or foe? Presidential Address to Ulster
developed is unknown, but it is clear that it is a real phenome- Medical Society, 4th October 2012. Ulster Med J. 2014;83(3):
non. We have begun to reduce the ordering of spine MRIs not 158–167.
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ternal radiation from diagnostic imaging procedures. Ca Cancer J
The limitations of this project are few patients and it is a snap- Clin. 2012;62(2):75–100.
shot in time. The Operators who sought care are not typical 12. Stankevicins L, da Silva A, dos Passos F, et al. Mir-34a is up-reg-
ulated in response to low-dose, low energy X-ray induced DNA
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a high pain threshold and a “never quit” attitude. The con-
secutive nature and continuity of care bring consistency to the
approach by a team of physicians with experience in managing
musculoskeletal injuries in athletes.

Conclusions
We draw three conclusions from this study. First, because al-
most all cases had a soft-tissue injury component, MRI allowed
for definitive diagnosis as well as definitive triage for care in
a timely manner, decreasing the time to returning to mission
ready status. Second, Operators have high pain thresholds and
avoid complaining; when an Operator complains of pain or
dysfunction, and MRI is performed, a positive finding is not
uncommon. Guidelines for ordering lumbosacral MRIs should
be followed and not ordered for pain that is not progressive
and severe or not associated with a neurological finding.
Third, because radiographs do not aid diagnosis of ligament,
tendon, and cartilage injuries in these patients with this injury
pattern, and there is a risk of X-ray exposure in patients of this
age, X-rays should be avoided in this setting unless definitely
indicated.
Disclosures
The authors have indicated they have no financial relation-
ships relevant to this article to disclose.

Author Contributions
All authors approved the final draft of this manuscript.
July 30 - August 01, 2018
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