Thursday, February 3, 2011
When you hurt your back (or ankle, or wrist) and head to the doctor, do you expect an x-ray? I find that many patients are surprised if I do not insist on an x-ray for an acute injury. Mind you, I certainly order plenty of x-rays when I believe that the results will change our management (is it a broken bone or a sprained ligament), or even if the results simply tell us what to expect about the time-frame for healing, such as a minor fracture in the foot or toe.
By the way, while we're on the subject, a SPRAIN happens to ligaments, the tissue that attaches bone to bone. A STRAIN occurs in muscles or tendons (tissue connecting muscles to bones.)
So back to XRAYs. XRAYS look at bones. They do not "see" cartilage, muscles, tendons or ligaments, though sometimes distance between bones suggests lack of cartilage. The vast majority of injuries that send patients to their doctors are not from broken bones, but strains and sprains and spasms of muscles and supporting tissue. As we try to limit both unnecessary radiation and expense, the world of medicine is taking a closer look at when interventions such as taking xrays are really needed to improve patient outcomes. Medical centers are developing guidelines for different injuries that help physicians determine when an xray is truly needed, such as the Ottowa rules for ankle injuries.
RICE: Rest, Ice, Compression and Elevation (plus a bit of pain-reliever/anti-inflammatory medicine such as ibuprofen) go a long way towards treating injuries. Your doctor can show you the best way to compression wrap an extremity, plus possibly prescribe muscle relaxants or stronger anti-inflammatory medicine. Perhaps most importantly, your doctor may prescribe PHYSICAL THERAPY- where you will learn strengthening, flexibility and stability for your injury to fully rehab.
BOTTOM LINE: XRAYS are helpful diagnostic tools for bone injury, but don't assume your treatment of an injury isn't complete without one!