Sara Shupe, MSPT, Dip. MDT is a physical therapist specialist and founder of J.O.Y. Physical Therapy Inc, a mobile and tele-health physical therapy provider servicing the Twin Cities Metro Area, greater Minnesota, and Wisconsin. Sara has presented early access models of mechanical diagnosis and therapy (MDT) in the treatment of low back pain to the American Physical Therapy Association (APTA), National Association of Spine Society (NASS) and The international MDT Conference. Sara lives in Eagan, MN with her 14 year old son and Daus Haund mix puppy.
For a moment I forgot I was crowned with the silver and gold(en) years. I have to keep up with my teenagers on the rink (for those non-Minnesotan readers of mine, that is a ice hockey reference), right? That skateboard-do-hicky-thing doesn't look too hard. Let's show those Gen X-ers what the middle-aged can do.
Then it becomes an Instagram video played over and over and over...look at mmmoooommm...
It. Is. Broken.
Do you really need a elbow surgery?
Research in orthopedic medicine has had a difficult time proving the reliability and validity of certain tests
practitioners will do to determine if a middle aged elbow fracture patient would respond best to surgery or non-operative management. A recent article from Desloges et al found that radiologic and CT tests done in the ER haven’t been found to be predictably reliable in determining successful outcomes (J Shoulder Elbow Surg 2015). In English, that means despite all the testing, we don't know who will do better down the road. Some international studies suggest that the grand majority of these patients should heal without surgery. Furthermore, once an elbow has healed non-operatively, it was found that the likelihood of needing a surgery in the future from the "post-traumatic arthritis" or some-other-scary-phrase is very uncommon despite all the hoopla. So why are Americans being told this?
The economics of orthopedic care.
The going rate of an average elbow surgery in this country is $20,000. That is "without complications." Add an infection in there and your rate could double. If you have a $20,000+ deductible like many Americans, you pay it. Kiss that Australian vacation goodbye!
In a few cases, the presence of radial (the bone on the inside of the elbow) fracture demonstrates significant pathology (i.e. instability) and thus requires surgical intervention (envision a bone moving around after a fall, pinching off the necessary arteries and nerves to this bones of your wrist and/or hand). However, after the initial healing phase of the fracture, the majority of middle-aged folks do not need surgery both at the time of fracture, or years down the road.
Instead of surgery, it has been found that otherwise healthy people can demonstrate positive outcomes from a treatment called Mechanical Diagnosis and Therapy or MDT. It has been shown to be efficient and less expensive. With the mounting costs of treatments for musculoskeletal disorders in this country, MDT is a breath of fresh air for those searching for more efficient, less morbid, and less expensive methods of care.
By treating healed elbow fracture patients with MDT we’ve managed to:
* Improved patients’ function long term, more efficiently
* Reduced the likelihood for expensive and unnecessary scans and surgeries etc.
Seek out a MDT provider in your region at www.mckenzieinstituteusa.org or call 651-800-MYPT if in MN or WI.
Well, as you know if you are someone who frequents this blog, there is Good News!
The best way to understand how to manage your elbow pain is not to look at an X-ray, but rather to move it!
What have we learned?
- X-rays are not a valid measure of determining the need for any surgery after a trauma.
- When in doubt, seek out a MDT provider in your region at www.mckenzieinstituteusa.org
Anyone want to save $20,000 worth of pain and suffering?