Imagine a person who starts with tingling and loss of strength in one leg. This person comes to the doctor and it also hurts the lower back. The situation seems clear; you must have a herniated disc. An MRI is then made and confirmed to have a hernia. Counted like this seems to be the cause, but we can be wrong. Could this not be this and that it is a multiple sclerosis, for example? The physical examination in the consultation has much to say.
Many times I respond in the comments of the web that the most important is the patient’s history and physical examination and that the tests are complementary aids. I want to use this example to understand why it is so. If we do not reconstruct the facts and guide the diagnosis, the evidence may confuse us. Lumbar pain is 80% of the population at some point, that is, it is very common. If we did an MRI of the lumbar spine to everyone, we would be surprised how many hernias we would see without any consequence. So the question would be: is the hernia we see in the resonance guilty of the symptoms?
What should the doctor do? The first step is always to look at the background and ask the patient about the evolution of the facts. It is not the same to fall down the stairs and start with tingling in the leg than to get up one day with fever and discover that we have no strength in the foot. History already guides you to the possible origin of the problem. In this sense, there are examples we all want. If we do not reconstruct the facts we can lose key data for the diagnosis.
Then comes physical exploration. If the doctor has focused the problem well the exploration will often give definitive data. Going back to the initial case, everything has to square. If a person has a hernia L5-S1 that is touching the root S1 (seen in resonance) and the symptoms are that it loses force in the quadriceps, this does not fit. The root S1 does not innervate the quadriceps, the cause will be elsewhere. Without exploration, things will be overlooked and errors will appear. In this case the consequence might be unnecessary surgery, for example, in addition to not solving the problem.
Nowadays advances in technology are causing many professionals to rely too much on the tests and to leave aside the fundamental, which is the clinical examination that we are commenting. I remember on one occasion how a friend referred me to a family member concerned about the results of his spinal resonance. I brought the test and saw several crushed vertebrae with images that suggested tumor infiltration. Of course he was frightened by what he had read in the report. When performing the examination, only mechanical pain without deformities and normal mobility was observed. Clearly it did not make sense and inquiring, luckily, we saw that the resonance that had been given to him was not his. You can also give the opposite case.
In short, we should not be dazzled by the modern evidence that exists. What is most valuable in arriving at a diagnosis is an experienced professional who will properly explore the patient. The same is true for deciding whether a person should undergo surgery. As it is often said among doctors, “no resonances are operated, patients are operated”.
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