The Slippery Slope of Treatment Escalation For Musculoskeletal and Spinal Injuries
In the medical field, particularly when dealing with spine and musculoskeletal injuries, the line between necessary intervention and overly aggressive treatment can sometimes become blurred. The journey from diagnosis to recovery is not always straightforward, and the escalation of treatment can often lead to an array of unnecessary procedures, increased costs, and potentially adverse outcomes for the patient.
The Initial Steps
Consider the case of a 32-year-old patient who suffers an acromioclavicular (AC) joint separation due to a heavy lifting incident. The immediate response, driven by a desire for quick and comprehensive care, leads to an ultrasound revealing supraspinatus tendinosis. This condition, while important to identify, is not directly related to the AC joint injury itself.
The Escalation Begins
Following the ultrasound, an X-ray is recommended to rule out fractures, dislocations, or bone pathology—despite these not being primary concerns given the nature of the injury and initial findings. The X-ray results return negative, as expected for a soft tissue injury like an AC separation. Yet, the pathway of escalating diagnostic tests doesn't stop there. An MRI with contrast is then suggested to investigate the possibility of a labral tear, an issue typically associated with trauma but not necessarily indicated by the patient's symptoms or injury type.
The Costs Accumulate
The financial implications of this treatment escalation are significant. Not only does the Alberta health care system absorb the costs for the ultrasound and X-ray, but the patient also faces an additional fee for the contrast-enhanced MRI. Beyond the financial burden, the introduction of contrast via needle into the joint raises concerns about accelerating joint degeneration—a risk that may not be justified given the low likelihood of finding a labral tear related to the AC separation.
Potential Downstream Effects
Once the extensive and costly diagnostics yield negative results, the direction of treatment may turn towards injection therapies such as cortisone, Platelet-Rich Plasma (PRP), or prolotherapy. While these treatments have their place in managing certain conditions, they do not specifically address the AC separation and could lead to further unnecessary medical interventions.
The Argument for Conservative Management
This case highlights the importance of considering conservative management strategies, especially in the early stages of treating musculoskeletal and spinal injuries. Rest, ice, and physical therapy represent foundational elements of a non-invasive approach that can effectively address the pain and dysfunction associated with an injury without exposing the patient to the risks and costs of escalated treatment.
Similarly, low back pain patients also experience treatment escalation when provided unwarranted treatments such as injections or surgeries where the general initial LBP treatment guidelines are conservative and non-pharmacological.
The pathway to recovery should be navigated with careful consideration of both the short-term and long-term implications of each diagnostic test and treatment option. By prioritizing evidence-based, conservative approaches, healthcare providers can not only optimize patient outcomes but also minimize unnecessary healthcare spending and avoid the potential harms of over-treatment. As we move forward, striking the right balance between necessary intervention and conservative management will be key to delivering high-quality, patient-centered care.
Are you experiencing spinal or musculoskeletal problems? Reach out to us at Westside Chiropractic to get help through natural, non-pharmacological methods.
