Start with X-ray for most adult joint pain
Plain radiographs evaluate alignment, fracture, dislocation, degenerative joint disease, and many post-operative questions, and they are appropriate as a first study for the vast majority of adult joint complaints. Standard weight-bearing views are particularly important for the knee, ankle, and foot.
Escalate to MRI for internal derangement
MRI without contrast is the workhorse for soft-tissue, cartilage, ligament, tendon, and bone marrow evaluation. It is the right next step when the history suggests a meniscal tear, rotator cuff tear, ligamentous injury, suspected stress reaction or occult fracture, or persistent pain with a non-diagnostic X-ray.
When to add arthrogram
MR arthrogram improves sensitivity for labral pathology and for evaluating articular surfaces in select scenarios — most commonly shoulder labral tears and femoroacetabular impingement work-up in the hip. Conventional MRI is appropriate first-line; arthrogram is requested when the surgeon needs the added intra-articular contrast or when prior MRI was equivocal.
Hardware and post-operative joints
Plain radiographs remain the first study after orthopaedic instrumentation. MRI is feasible around most orthopaedic hardware using metal-artefact-reduction protocols when soft-tissue evaluation is required; CT is an alternative when MRI is contraindicated or when high bony detail near hardware is the question.
Suspected infection
When septic arthritis or osteomyelitis is in the differential, MRI with and without contrast is the highest-yield study and should be expedited. Persistent joint effusion with systemic signs warrants aspiration referral in parallel with imaging.
Ordering with Precise
X-ray, MRI, and MR arthrogram are available across the network with MSK fellowship-trained sub-specialty reads. Many of our locations offer 3T and open-bore MRI to accommodate patient size and anxiety.
Questions referring offices ask first.
When should I skip X-ray and go straight to MRI?
Skip X-ray only when the question is purely soft-tissue, the joint has been recently imaged with X-ray, and the patient is being evaluated for internal derangement or stress reaction.
Do I order arthrogram or MRI first?
Order conventional MRI first unless the specific question (e.g. shoulder labral tear with high pre-test probability and surgical planning) warrants arthrogram up front.
Educational reference for referring providers. Not a substitute for clinical judgement or the current official appropriateness criteria. References imaging modalities offered by Precise; modalities not in our network are out of scope.