Arthritis, Imaging, and Other considerations
 
“It is common to encounter patients who have been told they need a joint replacement or other surgical procedure based only on a cursory exam and radiographic test. But then with a more extensive history and physical, a problem which can be rectified none surgically is identified.”

The history and physical is the cornerstone of medical diagnostics.  With musculoskeletal disease it must account for the kinetic chain, neuromuscular dysfunction, and co-morbid disease.  Imaging should predominately be used to confirm a diagnosis.  When joints are imaged in volunteers with no to minimal symptoms, an abnormality is generally found.  In one study, in asymptomatic patients with an average age of 38, magnetic resonance images of the shoulder revealed abnormalities in 73% of shoulders, with labral tears being identified in 69% of the joints (American Journal of Sports Medicine).  Without information directing to the source from the history and physical, to much emphasis is placed on radiographic findings.  Additional examples will be given below.


Similarly, many patients are not given an effective history and physical, particularly one considering the kinetic chain and neuromuscular dysfunction.  Instead the patient gets a plain film.  The doctor sees early arthritis and tells the patient either it is aging or they need a joint replacement. 


To often patients are given the diagnosis of arthritis because other reversible disorders are not throughly ruled out.  Arthritis is a disease of predominately dysfunctional mechanics, the kinetic chain and neuromuscular dysfunction, rather than just aging.  We will illustrate this point with two animal studies.  Scientists avoid animal studies because sacrificing any life is sobering.  But some information can’t be obtained definitely from human studies.  In one series of studies rabbits ,who are medicated to feel no discomfort, had Botox injected into their hamstrings (leading to muscle weakness).  Even though joints were untouched, in the knee (for example) arthritis developed in all four sections (Osteo Cartilage 2014).  The joint was never manipulated and it was obviously not due to aging.  The arthritis was caused purely by dysfunction of the kinetic chain. 


In another study, arthritis was induced in rats again medicated so they felt no discomfort.  The arthritis was induced by ACL/meniscus laceration in one knee.  Arthritis developed in this knee but also in the opposite untouched knee. 


IN EITHER OF THESE CASES, WAS THE ARTHRITIS DUE TO AGING?  No!  IN EITHER CASE, WOULD IMAGING THE KNEE IDENTIFY THE CAUSE AND DIRECT TREATMENT?  No!!  Then why are so many patients managed this way? 


So in addition to an excellent routine history and physical, SeizeHealth focuses on:

  1. 1.Kinetic Chain

  2. 2.Neuromuscular Dysfunction

  3. 3.Co-Morbid Disease

  4. 4.Integration with PT/Fitness Centers

 

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Imaging Video (CLICK)https://youtu.be/GXgS3og3ySUshapeimage_3_link_0