Never underestimate the importance of motion palpation

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Over the years I have personally witnessed time and time again a misdiagnosis.  The classic case is the individual with said "hip pain" and diagnosed with degenerative osteoarthritis of the hip as seen on an x-ray/MRI and the recommendation of complete hip replacement.  I have learned to never take that diagnosis at face value.  More often than I can count, after a complete physical examination I find the real culprit to be the lower spine, facet damage, bursitis or one of the sacroiliac joints.  Yes, they may indeed have some degenerative OA of the hip but if that's not causing the pain, then what good is it to perform a total hip replacement only to observe the patient when the surgery is complete and the pain remains!

This phenomenon can easily be related to any other joint in the body as well.  I'm always shocked after the exam when a patient remarks, "Why didn't my doctor do that?" and I say, "Do what?" "You felt around and moved me around in different positions until you found my problem, my doctor never touched me." Wow, just wow.

 I don't understand the omission of the physical exam by many doctors.  Getting a second opinion is always a good idea when something like spine surgery or a total joint replacement is recommended.  And with the advancements of today, options like stem cell therapy is proving to be a major game changer and making the spine surgery/joint replacement folks very nervous.  Don't get me wrong, joint replacement surgery will never go away as there are times when it is completely necessary.  But, necessary is becoming less and less common.