Question:I've seen two different orthopedic surgeons about a shoulder problem. One thinks it's bursitis, the other says it's a rotator cuff tear. I get the feeling if I saw a third doctor, I'd get a third opinion. Am I right?
Answer:Shoulder problems can be difficult to diagnose. Even when orthopedic surgeons agree as to the cause of the underlying problem, there may be different ways to describe or classify the condition.
For example, rotator cuff tears (RCTs) can be classified in nine different ways. Three of those methods are similar so for the sake of argument, we could say there are really only six methods.
Even so, if every surgeon used the same method, they still wouldn't always come up with the same opinion. Experience and training may account for some of these differences. Some orthopedic surgeons specialize in shoulder problems, taking an extra training period called a fellowship.
Arthroscopic exam is really the best way to sort out the exact cause of the problem. There are reasons why an arthroscopic exam isn't done routinely on everyone with shoulder pain.
Sometimes it's less costly to treat the condition for a short time and then re-evaluate. The more expensive testing can be done later if treatment fails to help improve symptoms. Knowing for sure what is the cause of the problem does help direct the patient to the most appropriate treatment for that problem.John E. Kuhn, et al. Interobserver Agreement in the Classification of Rotator Cuff Tears. In The American Journal of Sports Medicine. March 2007. Vol. 35. No. 3. Pp. 437-441.
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