Misdiagnosis remains one of the most catastrophic and costly of medical errors. A misdiagnosis of musculoskeletal pain leads to a domino effect of wrong treatments, prolonged pain, potential inappropriate surgeries, chronic symptoms, and disability.
Uncovering the true cause of symptoms is critical and should be the primary focus of all clinicians. Unfortunately, there is minimal to no research on misdiagnosis of musculoskeletal pain. When someone has muscle or joint pain, they are often diagnosed based on their MRI findings or the location of their symptoms.
An MRI shows a clear picture of deep underlying structures. But a picture cannot differentiate painful from non-painful tissues. Similar to taking a picture of the motherboard in your cell phone – the image may show water damage or no damage at all, but a photo will not tell you if your phone is working correctly. Only by using your phone can you determine if it works. This is the same for our muscles and joints. An MRI may show damage and imperfections, but many of these findings are natural age-related changes. Just like grey hair and wrinkles occur as we age, they do not cause pain. Unfortunately, changes found on an MRI are often automatically blamed for the cause of pain. But in reality, many MRI findings, such as a herniated disc or torn rotator cuff, are asymptomatic and not the actual cause of symptoms! (More than 50% of rotator cuff tears are asymptomatic. 60% of disc bulges are asymptomatic, instead, they are often natural changes that happen as we age.)
Recent research has found that 43.5% of isolated extremity symptoms originate from the spine. When you have pain in a joint, such as your shoulder, knee, or wrist, without any neck/back symptoms, you have a 43.5% chance that your pain comes from a problem within your back! Uncovering the root cause of symptoms is critical and leads to improved outcomes.
Typically, pain in and around our joints is taken at face value, and the painful joint is diagnosed as the causative factor, but symptoms may be referred from the spine. If your shoulder hurts, you take for granted you have a shoulder problem, but research has found over a 40% likelihood that the problem originates in the spine. Getting an MRI before a thorough mechanical assessment may increase your risk of being MISDIAGNOSED because it is easy to blame the first thing we see. When pain of spinal origin is misinterpreted as a local problem, it can initiate a cascade of inappropriate care.
There is ample research on the management of shoulder, elbow, wrist, hip, knee, and ankle disorders but minimal on the prevalence of symptoms referred from the spine. The spine can refer pain, numbness, tingling, weakness, and muscle spasms in the arms and legs.
Understanding the root cause of symptoms is critical for proper treatment.
Potential Reasons for misdiagnosis of musculoskeletal pain:
1. Most clinicians DO NOT rule out the spine.
2. Reliance on MRIs without understanding normal age-related changes.
3. Lack of time to go through a thorough physical examination.
6. Lack of research, teaching, and discussion about the
importance of clearing the spine.
4. Specialized physicians that only treat one and often do not evaluate/treat outside of their joint specialty.