Diagnostic Testing for Musculoskeletal Injuries

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By Dr. Kevin Bloom
Published on August 18, 2013

Do Diagnostic Testing Results Matter for Musculoskeletal Injuries?

Tests for musculoskeletal injuries may be inconclusive.

Tests for musculoskeletal injuries may be inconclusive.

There are certainly cases where diagnostic testing and further investigation are warranted.  Sometimes, specific results can alter the plan of management and prove helpful in the case at that moment.  As an example, severe knee osteoarthritis seen on diagnostic testing of which is unresponsive to conservative management (chiropractic therapy, physiotherapy, acupuncture) might warrant a referral to an orthopedic surgeon to discuss the possibility of a knee replacement or to a rheumatologist to discuss the possibility of a cortisone injection.  In these particular cases, often descriptive terms such as “severe,” “large,” “complex,” or “significant” are commonly used by the radiologist to more thoroughly describe the extent of structural findings.

Tests For Musculoskeletal Injuries Are Sometimes Unhelpful

That being said, and more often than not, diagnostic testing results are often inconclusive.  Such results do not often alter the plan of management.  It is often difficult to accurately correlate the findings to the patient’s case.  As I often tell my patients when they present to my office with test results, the question is not whether something was seen on the test but rather whether what was seen actually relates to the specific clinical presentation.

As an example, a patient with moderate knee osteoarthritis presents for therapy.  This patient might end up doing really well under conservative management such that he/she achieves a full or close to full recovery for which is reasonably sustainable.  The same moderate knee osteoarthritis is present on radiographs pre and post conservative management.  It is often difficult to pinpoint the reason for recovery.  Maybe the patient’s problem was not significantly, if at all, related to the test findings as seen.  Maybe the positive effects of treatment and exercise (eg. increased range of motion/mobility) countered the negative effects of the diagnostic testing findings (eg. stiffness due to osteoarthritis) such that the patient achieved a good recovery.  It is hard to know.  The final result is typically all that matters anyways.  It should be noted that in the case of moderate osteoarthritis specifically, such arthritis might eventually worsen somewhere down the road to severe osteoarthritis for which a test at that juncture might then affect the plan of management.

Especially when diagnostic testing results appear inconclusive, the focus should be on resolving functional impairment (eg. range of motion, strength).  Often, patients with increased mobility and/or increased strength have correlated symptom reduction and functional restoration with respect to their regular activities of daily living.  So, in these commonly seen clinical cases, does the test result matter when ultimately a reasonable level of recovery is achieved anyways?   I don’t think so.