Thursday, April 30, 2015

Looking At the Whole Picture

Medical tests have evolved dramatically over the past 50 years. MRIs are revealing details of the anatomy that we could not see historically. The advances are incredible and valuable, but as physicians, we must remember the importance of looking at the full picture.

In my experience, each tool we use fits a piece of a puzzle that reveals the most appropriate treatment protocol. We cannot and should not depend solely on imaging to determine if surgery is needed. The imaging tools today are advanced and may show an injury that is not necessarily the root of the pain. In order to determine the most appropriate treatment we must also rely on the physical exam and medical history of the patient.

Traditional physical exams are vital to identifying the appropriate course of action when treating patients. For example, a patient complaining of shoulder pain may have an MRI showing multiple injuries. However, it is possible that one injury was pre-existing and not the root of the pain. By utilizing physical exams, such as the Hawkins-Kennedy Impingement Test or the Neer’s Test, we can identify the injury causing pain and then use the MRI to gather more information. 

It is vital to talk to patients and gather information about their personal medical history. By understanding the type of work they do and the lifestyle they lead, we can determine the treatments that will be most effective. For example, certain surgical procedures may be more appropriate for athletes, while a more conservative approach may be the better option for someone who works a desk job. 

Imaging provides physicians with the ability to see inside the body and identify the scope of the injury or condition. X-rays give us a way to see bones and diagnose fractures and arthritis, while MRIs allow us to see the soft tissues. CT scans provide images of internal organs, bones, soft tissue and blood vessels and are able to provide greater detail than traditional x-rays, particularly of soft tissues and blood vessels.

In this technologically advanced world we live in, it is important to remember that all the diagnostic tools tie together to create the most appropriate treatment plan for each patient. If we as physicians solely relied on one piece (i.e. imaging) we may be doing a disservice to the patient and miss a detail that could be vital to that person’s recovery. In an upcoming series, we will review tests that are used during orthopedic physical exams and describe what each test is used to diagnose.