Clinical Stories – part 3

Spyros fell off his bicycle and injured his right elbow. The severe and persistent pain led him to the hospital, where radiographic examination (Fig. A) revealed a fracture of the radial head. He was advised to undergo conservative management with immobilization, analgesics, and physiotherapy after a period of 6 weeks. If the joint range of motion is gradually restored, surgical stabilization can be avoided.

Following a viral infection, Margarita developed increased sensitivity in her respiratory system with a persistent and intense cough. Four weeks later, she began to experience low back pain, which led her to seek medical attention at the hospital. An X-ray was performed (Fig. B), which, however, did not clarify the diagnosis. Thus, the question remained unanswered: what is actually causing her symptoms? A spinal structure? The pelvis? The hip? Or could it be renal referred pain?

It is widely accepted that the differential diagnosis of the neuromusculoskeletal system, when based exclusively on imaging methods, demonstrates low sensitivity and specificity, often leading to incomplete or inaccurate diagnosis. Maximum objectivity and the highest possible level of scientific validity (evidence-based practice) are achieved through the development of clinical reasoning, grounded in a detailed patient history and an extensive clinical examination.