A Correct Diagnosis Makes ALL the Difference

Common sense dictates that you cannot treat a repetitive strain injury until you know what it is.  But it happens time and time again, leaving behind a trail of lackluster results, and the patient highly discouraged.  There are three groups involved in this issue, and with a little foresight, patients can look forward to good results with long lasting effects. 

The first of these groups involve physicians that incorrectly diagnose a condition.  For example: The patient complains of pain, numbness, paresthesia and tingling in first three fingers (thumb, index and middle), with increased symptoms at night which causes them to awaken frequently. 

These are the “classic” symptoms of median nerve impingement within the carpal tunnel, thus by all reasoning, would be diagnosed as carpal tunnel syndrome.  Of course this could be easily cleared up with a few manual tests like Phalen’s, Reverse Phalen’s Tinel’s Sign and Compression Test. Instead, the physician Diagnoses it as Guyon’s Syndrome, an ulnar nerve disorder that affects the ring and pinkie fingers and has absolutely nothing to do with the thumb, index and middle finger symptoms that are presented to the physician. 

An incorrect diagnosis like this can easily lead to further damage as the individual begins rehabilitation and the prescribed therapy is addressing a condition that is not even present. Performing incorrect rehabilitation, such as massage, stretches and exercises for the wrong type of injury can exacerbate the “real” condition, resulting in possible irreversible damage to the affected muscles and nerve.

The second issue involves therapists that do not double-check the physician’s original diagnosis and then implement rehabilitation methods that exacerbate and increase the existing symptoms. 

When a therapist see’s a patient for the first time, they need to check the physician’s findings and perform the appropriate manual tests to double-check and be sure that the diagnosis they were presented with is correct. If they don’t, and the diagnosis is wrong, the therapists end up subjecting the patient to the incorrect rehabilitation program, possibly resulting in further damage to the patient.  

Even with a correct diagnosis and a manual retest by the therapist, the therapist still often employs the improper rehabilitation training methods anyway. For example: The patient again complains of pain, numbness, paresthesia and tingling in first three fingers (thumb, index and middle), with increased symptoms at night which causes them to awaken frequently.  Again these are “Classic” signs and symptoms of carpal tunnel syndrome.  The patient performs repetitive gripping and pincer motions with their hands all day in an assembly line.  It is clear that repetitive and prolonged finger and wrist flexion has caused the onset of the condition. 

So for therapy, the patient is subjected to a rehabilitation program consisting of “finger-walking” exercises, squeezing clay / putty and riding a hand bicycle.  Does is make any sense that the rehabilitation consists of performing the exact same exercises that the individual does that caused the injury?  That makes as much sense as having the patient work an extra few hours each night as part of their therapy in order to counteract the work they’ve done all day.  It is amazing how many therapists actually implement therapy techniques that mimic the motions that are at the source of the injury.

The last issue involves individuals self-diagnosing their own repetitive strain injury.  Although the track record of many physicians have given people plenty of reasons to think they can do just as good a job of diagnosing their conditions, if not better, they still need to get an accurate diagnosis. 

There is nothing wrong with looking into the condition yourself and taking the information you have found to your doctor.  And if you don’t like their answer, be sure to get a second, third, fourth or fifth opinion if necessary.  It is your health, not theirs and they are only human and are subject to making mistakes. The point here is that you need to be sure that more serious conditions are ruled out, and that you do in fact have a repetitive strain injury

Once you know what you are dealing with, find a good therapist that knows what they are doing and/or start your own therapy program at home, making sure that you are performing the appropriate corrective steps, such as self-massage, stretching and strengthening, that are necessary to correct the specific injury you have.

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