2003-07-18 / Columnists

Eye On Physical Therapy

By Tim Rohrs
Eye On Physical Therapy By Tim Rohrs

In the last Eye on Physical Therapy, I provided some resources for you to access so that you can become a better consumer of health care services. The most important resource of all is your very own doctor. Time and time again I hear patients complain that they don’t get the information they require. Many times the patient admits they forgot to ask the doctor or couldn’t remember the question once in the doctor’s office. I always recommend writing your questions down between visits and bringing them in with you so that you don’t forget.

Especially when it comes to having some type of surgery do patients have a difficult time. Many times they are dead set against having a surgery without having been informed about the consequences of not having the surgery or delaying the surgery. Here are 3 common scenarios that I observe almost on a weekly basis.

Patient "Mary" has had a knee injury and has been coming to physical therapy for a few weeks with good resolution of her symptoms. The orthopedic surgeon tells "Mary" that the MRI reveals a significant tear in her meniscus and recommends surgery to remove the tear. "Mary" being very cynical, suggests that the surgeon wants to perform an unnecessary surgery to help pay for a new boat. To "Mary" this may seem true. She is no longer having pain; she is able to run and bike and rollerblade. She is able to go up and down stairs pain free. If "Mary" had asked the surgeon why he recommends surgery she may have learned that meniscus tears left untreated often lead to pre- mature degeneration of the joint. The torn part of the meniscus can tear off completely and become a loose body floating within the joint. This can lead to the knee buckling and giving way while on stairs, as well as locking after sitting for a while. The probability that she will need a knee replacement has increased significantly because of leaving the meniscus.

"Jim" has had carpal tunnel syndrome (CTS) for a few months but it doesn’t seem to be progressing. He refuses surgery because the pain level doesn’t interfere with his daily living. He does not drop things like some other people with CTS do. The numbness and tingling is only at night. Physical Therapy has had little effect on his symptoms but "Jim" is not worried because the symptoms aren’t bad. His surgeon suggests a carpal tunnel release to relieve the pressure on the median nerve. "Jim" needs to consider that the pain and muscle atrophy (wasting) may progress and get worse at some time in the future. The longer he waits to have the surgery the greater the chance that the median nerve will have permanent damage. If "Jim" waits a year and decides to have the surgery and the nerve is already damaged, even having the surgery will not relieve the pain, numbness and tingling. There was a window for "Jim" to have the surgery and the window closed. "Jim" is now stuck with these symptoms for the rest of his life.

"Fred" had a complete tear of his rotator cuff. He has minimal pain but cannot really use that arm. In fact, he can’t even brush his teeth with that hand. He really doesn’t want surgery to repair the cuff. He wants to wait and see how much of his function he can regain through aggressive physical therapy. "Fred" needs to consider that the longer he delays surgery the more the muscle will retract and shrink. There may come a point in time in the future where the muscle has retracted so much that the surgeon can no longer stretch it far enough to be reattached to the bone.

The take home message is to ask questions. You not only have to find out what the surgery is going to help with, but what the consequences are of not have the surgery or delaying the surgery.


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