May 13, 2024 | chronic pain

Read The Patient, Not The Imaging Study.

David M. Glick, DC, DAIPM, CPE, FASPE, CEO and Medical Director of HealthQ2, brings over 30 years of expertise in evaluating chronic and complex pain pathologies.

Speaking with PAINWeek, he advocates for hands-on exams over relying solely on imaging studies. Dr. Glick challenges the conventional reliance on MRI imaging and 'problem-focused' exams in diagnosing upper extremity pain. Gain insights into commonly overlooked conditions like suprascapular nerve entrapment and understand the underlying reasons. Equip yourself with practical strategies for identifying common and uncommon conditions in complex patient cases. Watch the interview to enhance your diagnostic approach and ensure better patient outcomes!

Audio Transcript


David Glick: So the question I'm going to do is, why do we see constantly these neck and upper extremity patients that are falling through the cracks when they have something that could be treated? So what I've done for the neck and upper extremity session is I tried to take several different examples of what would be a common patient that would present to you as your office, as a primary care physician, because you're expecting that someone is going to be taking this problem apart and diagnosing it, and then coming up with an underlying reason. But I think what happens is most people are just throwing darts at the patient, hoping something's going to help. So by using these common examples of a patient that you would see every day, like I think the first example I give is in patient with neck and upper extremity symptoms that also has headaches. Classic. All too often you'll see the underlying cause of the neck and upper extremity pain separated out from the headaches. Yet they might be actually related. And if you can see how they're intertwined and see how overlapping conditions can change the presentation and make it a little confusing, but then you can see through it and know how to tease it apart. I think that is what sets that stage, because the problem that we see is, I mean, I've been in practice now for 33 years. I can't tell you how many times I've seen patients over the years that have had multiple back surgeries and seeing countless physicians, clinicians over the years, and yet you look through all the records and you can't find an example of somebody doing a clinically hands on clinical exam.


: And I think that things like that fall through the cracks. There was a study that came out last year after Covid. Two of them that I remember reading, one on cervical surgeries, one on shoulder surgeries where the the investigator said there was no difference between outcomes, whether the initial consult was done by telemedicine or face to face. Well, I was frustrated by that because if you look at the consults that were done face to face, they didn't include an examination anyway. So you can take patients off the street that have no back pain or neck pain whatsoever, and yet they're going to have disc bulges and herniations on imaging studies. So then how do you know when you see one on an imaging study that that's actually clinically significant? And I think that's the point. You have to be able to correlate the MRI findings or the imaging study findings with the presentation of the patient. I actually have a phrase that I like to use which is read the patient, not the imaging study. You can always bring back the findings of the imaging study as a piece of the puzzle, to give you a better idea of what's going on and maybe what treatment might be most appropriate. But read the patient first.