How do you approach diagnosing the patient with a knee or shoulder problem?

September 4, 2018

Making a Correct Diagnosis

Often, the most useful aspect of making the correct diagnosis of a knee or shoulder problem is by taking an accurate history as to the nature of the problem, that is to say, ask the right questions.  Most of the time a physician can narrow the problem down to a few possibilities, simply by understanding how the problem came about and have there been any clues in your past medical history.

Thorough Knee or Shoulder Exam

Next is a thorough exam.  A orthopedic surgeon will know the way a knee or shoulder should act when it is moved and stressed in various directions.  An examination of the uninjured joint is often used as a baseline.

By this point we are usually 95% sure of the diagnosis.

X-ray and MRI If Needed

The last 5% of diagnostic accuracy is facilitated by an X-ray and possibly an MRI.  Although X-rays show bone and not soft tissue, an X-ray can show signs of wear and tear that can demonstrate propensity for an acute problem.  Tissues that are worn are more likely to tear.

An MRI is certainly an accurate way to demonstrate soft tissue injuries, such as ligament, tendon or cartilage tears. The timing of an MRI is always the key question.  If your knee specialist believes that the injury requires immediate attention, such as knee surgery, an MRI should be done early on.  If the specialist feels the problem will resolve with conservative or non-operative treatment, then it makes sense to wait-and-see before doing an MRI.

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