took my son to his doctor for elbow pain. xrays fine said he just had a strain ok fine . ask him for a transfer to a sports med doctor to get a possible mri and he said no! what do i do now? anyone
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Find a new doctor for 2nd opinion. My son played a full year w/ broken wrist when our regular doc couldn't diagnose the tiny fracture. Took a hand surgery to repair the break, 1 year late!
Getting to a specialist through an HMO, if that's what your using, can sometimes be more painful than the injury itself. An MRI is usually a "referrable" issue in todays medical processes. That referral happens after the initial doctors "coarse of healing" is deemed not working.
I don't know the specifics of your sons injury, but, I do know that with most injuries that have strain/sprain symptoms an MRI is not the "next action". Because of the costs involved with an MRI, it takes some failed healing time from the initial diagnosis to get one scheduled.
If your the parent, you think this thought process sucks. If your an HMO member trying to keep costs down, you do not want every sprain/strain that comes into the clinic fast tracked to the MRI device.
I don't mean to be ngative, what I do suggest is be persistant and play within the medical game. Start by having the initial doctor set up a timeline of recovery before he refers you to a Sports Med specialist
I don't know the specifics of your sons injury, but, I do know that with most injuries that have strain/sprain symptoms an MRI is not the "next action". Because of the costs involved with an MRI, it takes some failed healing time from the initial diagnosis to get one scheduled.
If your the parent, you think this thought process sucks. If your an HMO member trying to keep costs down, you do not want every sprain/strain that comes into the clinic fast tracked to the MRI device.
I don't mean to be ngative, what I do suggest is be persistant and play within the medical game. Start by having the initial doctor set up a timeline of recovery before he refers you to a Sports Med specialist
An MRI isn't going to tell you anything.
You've got to look at the root cause of the problem. More likely than not, he has a mechanical flaw that is placing too much stress on some part of his body.
He may also be throwing too much.
You've got to look at the root cause of the problem. More likely than not, he has a mechanical flaw that is placing too much stress on some part of his body.
He may also be throwing too much.
I agree with rz1, if you are under an HMO, then the doc you saw can't give a referral for this injury until sufficient time/therapy has passed.
We sat out one summer with pain related to a stress fracture that wasn't viewable on X-Ray.
... And some injuries won't show up on MRI's either, they take Bone Scans. An MRI isn't a magic bullet nor is it infallible.
You will have to treat it symptomatically until the pain is gone. Once it has disappeared, then get in with a good pitching coach to see if he has a mechanical problem. If the pain re-occurs and his technique is fine, then you can probably get an MRI and go from there.
We sat out one summer with pain related to a stress fracture that wasn't viewable on X-Ray.
... And some injuries won't show up on MRI's either, they take Bone Scans. An MRI isn't a magic bullet nor is it infallible.
You will have to treat it symptomatically until the pain is gone. Once it has disappeared, then get in with a good pitching coach to see if he has a mechanical problem. If the pain re-occurs and his technique is fine, then you can probably get an MRI and go from there.
quote:An MRI isn't going to tell you anything.
You are a Licensed Physician AND a coach, Chris?
This is a good time of year for a break anyhow. Give it 3-4 weeks of complete rest. After that, slowly work on coming back up to speed. If the pain persists, then push for a sports ortho.
Elbow pain basically can come from overuse (even with good mechanics), mechanics that place undue stress on the elbow, or a traumatic injury. Figuring out which was the likely cause can help prevent recurrence. Good luck.
Elbow pain basically can come from overuse (even with good mechanics), mechanics that place undue stress on the elbow, or a traumatic injury. Figuring out which was the likely cause can help prevent recurrence. Good luck.
No, but I've read the studies and they indicate that X-Rays are generally more reliable diagnostic tools than are MRIs. The problem is that a bone problem will generally show up in an X-Ray and an MRI isn't a great way of detecting soft tissue injuries, especially those that are of a generalized nature.
Ghoti - I'm sending you a PM
A MRI is the diagnostic tool of choice if conservative treament fails and an x-ray is non-diagnostic which they often are if it's a soft tissue injury.
Ghoti...you have a PM
I am not a doctor either. However "wet" (dye injected) MRI's are used very effectively to diagnose and non-diagnose soft tissue injuries, based on recent, first hand experience. A word of caution. A wet MRI hurts. Not pleasant to go through.
With that said, if you can't get a referral that information is not useful. As stated, you are subject to the plan you are on. Check your plan to see if you actually need a referral to visit a specialist or what type.
With that said, if you can't get a referral that information is not useful. As stated, you are subject to the plan you are on. Check your plan to see if you actually need a referral to visit a specialist or what type.
My point isn't about the relative benefits of X-Rays versus MRIs.
My point is that you should try to understand the root cause of the problem rather than spending all of your time on the treatment. All of the treatment in the world won't help if you don't understand and address the root cause of the problem.
My point is that you should try to understand the root cause of the problem rather than spending all of your time on the treatment. All of the treatment in the world won't help if you don't understand and address the root cause of the problem.
Dad04,
Good first response.
I am not an xray technician, so I wouldn't even venture to guess what is the difference between an xray and an MRI, except that an MRI gives a different view or views of the area in question and into deeper tissue.
Regarding insurance, doesn't matter if you have an HMO or PPO. A good point is made that an MRI is expensive and a doctor has to justify the test.
In my experience and understanding an xray is taken first, then a plan is made by the doctor which might include rest, anti inflammatory. Then possible therapy which would include massage, elec stim and excercise to strenghten the area. If all else fails and pain still persists, the doctor might choose an MRI to see if there are any problems the xray did not pick up.
The elbow pain could be a sign that some adjustments need to be made, not necessarily a major problem. But that can't be determined until the pain goes away. The body is sending signals something is not right.
Unless you have visited a doctor who specializes in sports injuries, it's pretty hard to tell anyone what might be causing the problem, especially over the internet. When son suffered a bout with tendinitous a few years back it took 3 months (not an HMO) before the doctor decided to do an MRI, which resulted in nothing of significance. Physical therapy and a good rehab throwing program before season started, took 5 months. Fall ball was cut immediately and then in the off season they worked on teh long toss. This whole episode was the result of throwing a screwball incorrectly (which he shouldn't have been throwing at all).
This year son suffered a bit of tendinitous in his shoulder. Xray's showed nothing. He went on 2 weeks complete rest, therapy and then a rehab long toss program before he went into the bull pen to see if the shoulder was ok. It was a little bit faster process than before as he had therapy available whenever he wanted and a trainer. No MRI was needed, just rest, anti inflammatories and a good program to get back on track. This was a result of not beginning his long toss program early in aug and hitting the bull pen too early, a major cause of injury before teh season even begins.
I can't believe how many times I hear parents say they took their son to a doctor and doctor said it was nothing serious, then next day son is back playing or in the gym, or back at the cage or throwing. The slight injury never has a chance to heal, then come season all h**l breaks loose. o not let anyone tell you it even MIGHT mechanics. Elbow pain is serious and NOT normal in many cases, though there may be referred pain in the AREA. Only a doctor can diagnose that.
Follw doctor's advice, if your son does not feel that improvement is being made, you might need that other opinion.
Health South offers a variety of doctors who specialize in sports injuries. You could call to see if there is one located near you and if the pain does not subside, politely ask for a referral to one.
Good first response.
I am not an xray technician, so I wouldn't even venture to guess what is the difference between an xray and an MRI, except that an MRI gives a different view or views of the area in question and into deeper tissue.
Regarding insurance, doesn't matter if you have an HMO or PPO. A good point is made that an MRI is expensive and a doctor has to justify the test.
In my experience and understanding an xray is taken first, then a plan is made by the doctor which might include rest, anti inflammatory. Then possible therapy which would include massage, elec stim and excercise to strenghten the area. If all else fails and pain still persists, the doctor might choose an MRI to see if there are any problems the xray did not pick up.
The elbow pain could be a sign that some adjustments need to be made, not necessarily a major problem. But that can't be determined until the pain goes away. The body is sending signals something is not right.
Unless you have visited a doctor who specializes in sports injuries, it's pretty hard to tell anyone what might be causing the problem, especially over the internet. When son suffered a bout with tendinitous a few years back it took 3 months (not an HMO) before the doctor decided to do an MRI, which resulted in nothing of significance. Physical therapy and a good rehab throwing program before season started, took 5 months. Fall ball was cut immediately and then in the off season they worked on teh long toss. This whole episode was the result of throwing a screwball incorrectly (which he shouldn't have been throwing at all).
This year son suffered a bit of tendinitous in his shoulder. Xray's showed nothing. He went on 2 weeks complete rest, therapy and then a rehab long toss program before he went into the bull pen to see if the shoulder was ok. It was a little bit faster process than before as he had therapy available whenever he wanted and a trainer. No MRI was needed, just rest, anti inflammatories and a good program to get back on track. This was a result of not beginning his long toss program early in aug and hitting the bull pen too early, a major cause of injury before teh season even begins.
I can't believe how many times I hear parents say they took their son to a doctor and doctor said it was nothing serious, then next day son is back playing or in the gym, or back at the cage or throwing. The slight injury never has a chance to heal, then come season all h**l breaks loose. o not let anyone tell you it even MIGHT mechanics. Elbow pain is serious and NOT normal in many cases, though there may be referred pain in the AREA. Only a doctor can diagnose that.
Follw doctor's advice, if your son does not feel that improvement is being made, you might need that other opinion.
Health South offers a variety of doctors who specialize in sports injuries. You could call to see if there is one located near you and if the pain does not subside, politely ask for a referral to one.
Coach Chris, Proper diagnstic testing is what is required to know the proper treament plan and to help find out what the "root" of the problem is. Then your course of treatment is based on these results. Without the proper testing, you don't know what/how to treat.
I agree completely with the importance of diagnostic testing. However, part of that diagnostic testing must be to look at and understand the throwing motion of the player.
Let me give you an example of why I feel so strongly about this (and feel like I have something to contribute).
This year I had a young pitcher who, after throwing just 1 amazing inning in the first game of the year, started complaining of medial elbow pain. Being the hyper-cautious person that I am, I decided to not let him pitch again until I knew what was going on.
After playing catch with him, watching him throw a striped ball (so I could watch the spin of the ball), and understanding what seemed to bring on the problem (he thought he was throwing a fastball but seemed to be able to stall the ball out over the plate) his father and I realized that he was inadvertently throwing a slider. This was because he was supinating his wrist as he released the ball.
Now, this may admittedly be a somewhat different case since the pain came up out of nowhere and I could feel pretty confident that it could be correlated to the inning he pitched. However, I wouldn't have solved the problem by taking him to the doctor. They would have diagnosed him with an inflamed medial epicondyle, would have told him to not throw for 3 or 4 weeks, and would have left the underlying flaw in his motion untouched.
If you want to solve the problem, then you have to look at the big picture, not just the symptoms.
Let me give you an example of why I feel so strongly about this (and feel like I have something to contribute).
This year I had a young pitcher who, after throwing just 1 amazing inning in the first game of the year, started complaining of medial elbow pain. Being the hyper-cautious person that I am, I decided to not let him pitch again until I knew what was going on.
After playing catch with him, watching him throw a striped ball (so I could watch the spin of the ball), and understanding what seemed to bring on the problem (he thought he was throwing a fastball but seemed to be able to stall the ball out over the plate) his father and I realized that he was inadvertently throwing a slider. This was because he was supinating his wrist as he released the ball.
Now, this may admittedly be a somewhat different case since the pain came up out of nowhere and I could feel pretty confident that it could be correlated to the inning he pitched. However, I wouldn't have solved the problem by taking him to the doctor. They would have diagnosed him with an inflamed medial epicondyle, would have told him to not throw for 3 or 4 weeks, and would have left the underlying flaw in his motion untouched.
If you want to solve the problem, then you have to look at the big picture, not just the symptoms.
quote:My point is that you should try to understand the root cause of the problem rather than spending all of your time on the treatment. All of the treatment in the world won't help if you don't understand and address the root cause of the problem.
We agree and that is true. That is different than saying an MRI can't find a soft tissue issue.
If the kid tore something, then all the corrective mechanics in the world won't fix it, either.
CC,
Your example may have validity and make sense. However, I think we (I) are talking about persistant pain. Most kids come to parents or coaches after it gets to a point that the pain is there, not just in throwing.
No matter what the reason, the persistant pain needs to be treated before anyone can decide what is wrong.
Your example may have validity and make sense. However, I think we (I) are talking about persistant pain. Most kids come to parents or coaches after it gets to a point that the pain is there, not just in throwing.
No matter what the reason, the persistant pain needs to be treated before anyone can decide what is wrong.
Coach Chris - You are 100% correct. I agree that mechanics or overuse are often contributing factors to pain. However, the physcian is the one to determine this and if it just an inflammatory process, then hopefully that physician and parent will turn to their coach or someone they trust to help develop better techniques.
If it was my son, and the pain is in fact of a persistent and chronic (e.g. didn't appear overnight) nature, then I generally agree with the advice of others and would shut him down until you know what's going on.
If you can post or send me a video of your son throwing, then I would be glad to look it over and see if I see anything obvious.
If you can post or send me a video of your son throwing, then I would be glad to look it over and see if I see anything obvious.