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Diagnosis is the key

Trying to solve an injury without knowing the exact diagnosis is like asking a mechanic to perform a repair without knowing which part needs to be repaired.

Even if it seems like a lie, the most reliable way we have today to make a precise diagnosis is... the usual one:

Let the patient explain himself, ask him about the details that can help us in the diagnosis and explore the patient. Often patients who come to my practice after visiting several specialists tell me that it is the first time that the doctor asks them to roll up their sleeves and touch them to explore them! PHOTO 1

I can affirm that by carrying out this apparently "archaic" procedure we will be able to arrive at the diagnosis in 90% of cases or at least hesitate among very few diagnoses.

For me, the complementary tests (CT, resonance, ultrasound, etc...) simply serve to corroborate the diagnosis or to finish deciding between the diagnostic options between which I am in doubt and to see the extent or characteristics of the injury to decide on the most appropriate treatment.

Broadly speaking, three large groups of patients arrive at our center:

A large group (approximately 70%) are patients who visit a specialist for the first time and who present a common pathology (arthrosis of the fingers or especially of the thumb, carpal tunnel syndrome, spring fingers, Dupuytren's disease and a very long etc... ). In these cases my mission is to carry out the precise diagnosis and, adapted to each patient, to find the most effective solution possible and in the simplest and least aggressive way for the patient. In other words, solve as soon as possible with the least discomfort for the patient.

A second group (approximately 20%) is made up of patients who present complex problems, sequelae of injuries, with previous surgeries, who have already gone through a good number of consultations or periods of physiotherapy and who do not see a solution. These patients are a real challenge for me and I take it on as a personal project. Almost always something can be done, but you have to dig deeper into the case and give it back to the solution and this is where I think my specialty just made sense.

The third group of patients (approximately 10%) are those who suffer alterations in the upper extremity as a sequel or in the context of another systemic disease such as rheumatic diseases with all imaginable associated injuries, neurological diseases, metabolic diseases like diabetes, etc... 
In these patients it is necessary to treat their injuries and I use the same principles as in the previous group, but in addition I have to coordinate the treatments with the other specialists who take the patient and talk with them. For me this is fundamental. The treatment of a specialist cannot be incompatible with another treatment that the patient is already undergoing... for this the solution is simple... pick up the phone and talk.
When starting a physiotherapy treatment, good doctor-physiotherapist communication is essential. Without this coordination it is much more difficult to achieve good results.

In all three groups, accurate diagnosis is the key to finding the best solution. Identify with maximum precision which, and how many structures are affected, see how the different injuries affect each other, treat each and every one and not stay with the first one we diagnose. 

An example: after tendonitis epicondylitis or "tennis elbow" there are up to 8 different pathologies that involve 5 tendons, several ligaments, a nerve and a meniscus. Each of these pathologies has different treatments and more than one can appear at the same time in the same elbow... and yet for many specialists today it remains a single diagnosis and they treat all patients the same.

In conclusion: listening, asking and touching... are the main keys to reaching the diagnosis. The tests are key to confirm this and help us decide the best treatment.

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