Sure You Got the Right Diagnosis?

This is a tough one. While running the Los Angeles Repetitive Strain Injury Support Group I noticed that many, many, many repetitive strain injury sufferers got lost in the healthcare system with the wrong diagnosis. The results were often years of ineffective or even harmful treatments while the patient got blamed for lack of progress. Sometimes, you have to diagnose your doctor.

The Diagnostic Codes

It's not entirely the practitioner's fault. They want to give you some relief, if not help with the underlying problem. But the insurance company has to approve that treatment first. With repetitive strain injuries, it's often difficult to know exactly which syndrome you have, especially if the patient reports "it hurts here" and no other details. So in order to get you treatment, the practitioner has to give you a diagnosis and assign a number to it. In our healthcare system, every malady has a code number for billing and approval purposes that corresponds with all the recognized diagnosis there are. Here's where the trouble lies.

Repetitive strain injuries reached epidemic proportions in the mid 1990s, far faster than science could keep up with. Each new site and each new type of pain was assigned a name, usually by the person who "discovered it" (DeQuervain's Disease), and given a diagnostic code. We've now wound up with more than 100 different RSIs and a complete mess.  

The Garbage Diagnosis

Sometimes a practitioner will give you what's known in medical circles as a garbage diagnosis. Tendonitis is one of the favorites. Again, it's meant to get you into the system and some treatment. But if you start practitioner hopping, you can end up with subsequent doctors focusing only on the garbage diagnosis that was never meant to be a permanent one to begin with. The trouble with tendonitis, for example, is that recent research shows inflammation is not present. Yet inflammation is a hallmark for other RSIs. So either they're treating you for inflammation, and you don't have any; or your practitioner is up on the latest research and not treating you for inflammation, when you have it.

Getting The Right Diagnosis

So how do you tell if you don't have the right diagnosis? If you're not seeing improvement, you might want to revisit your diagnosis. Again, the trouble here is that it often takes months of a particular treatment before you can measure any progress, so be patient and keep logs.

Another problem in getting the right diagnosis is seeing the right type of practitioner to begin with. In our healthcare system, your first stop is the primary care physician. They will often assume a repetitive strain injury is carpal tunnel syndrome and send you to an orthopedist. This is the appropriate specialty for CTS. However, pain in the hands can also be neurological or vascular, for which an orthopedist is decidedly not trained. In my view, it is always better at the diagnostic stage to see a practitioner trained in the whole body approach. This can be a physiatrist, a rheumatologist, an occupational medicine specialist or an osteopath. When seeking a second opinion, do include a practitioner in one of these disciplines.

Finally, there is the problem of convincing your doctor that she's wrong. Again, pain and functionality logs can help. So can a second opinion. You might not need to discontinue seeing that doctor, just to add another one to the team. If chronic pain has compromised your diplomatic skills, you might consider bringing a friend or loved one in to do the talking for you.

Good luck and write me with any questions.

@JillGambaro is the author of The Truth About Carpal Tunnel Syndrome . She advocates healthy playing for musicians through her Blog, Facebook and Twitter. Look for her upcoming documentary Icky Fingers.