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.
Exams
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.
History
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
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.