If you have knee or hip pain and/or arthritis, you need answers.  My job is to provide you with answers and a path forward. My goal is to provide a workable solution. Some of you aren’t comfortable even being in a doctor’s office; hopefully, my staff and I will help you feel comfortable sharing your story. I will share my training and over 20 years of experience to help you solve this little mystery. So even if we have yet to meet…thank you for reading how I go about making a correct diagnosis. Thank you for your visit and your willingness to allow me a place in your journey.

From the moment you walk into my office, my care team and I are looking for all the clues and evidence to not only make a diagnosis but determine the severity. Before we even begin to talk about the problem, I want to get to know you and see a glimpse into your life. Because this is about you. How active or inactive is your lifestyle? How is joint pain affecting you? To determine answers I/we:

  • Observe the patient
  • Listen to the patient
  • Examine the patient
  • Review imagining  (x-ray, MRI, CT scan)

Observation:  

When you walk, bear weight and even simply sit, I’m intently gathering clues to the severity of your condition and level of discomfort. I watch for the grimace across your face that tells me when you are experiencing pain.

Listen:

Let’s talk about your passions. You have taken time out of your life and I appreciate your willingness to share what your life is about with me; helping you live your desires fully is my life’s greatest passion. This time matters. 

The location of your pain matters. In the hip, for example, pain in the middle of the back might not be from your hip, as maybe you’ve assumed and been told. Groin pain, however, is exactly where hip pain usually occurs. Entire leg pain may be a sign of a nerve impingement.

As you tell me about your life and what you are about, I once again see the effects of a joint problem and how it reins in a life. Your stories and descriptions of pain are painting a picture of your limitations; this helps me define the problem. For example, I want to understand if you are still riding your favorite horse or ATV, or still traveling and sightseeing– which requires ample walking, or if you’ve had to discontinue things you love. Tell me if you’re still doing things like walking with your friends or not ready to give up skiing. I’d like to know whether or not these effects or changes are acceptable, or absolutely not acceptable to you, because at the end of the time we have I’ll be presenting you with options.

Examine:

The physical exam is key to making the correct diagnosis. Initially I will ask you to stand and walk–I’m looking at whether or not you use your affected leg or rely on arm strength to stand. I’ll look at whether or not you limp or favor the affected side. I’ll look for facial expressions–which hints at severity. Then I’ll ask you to lie on the exam table and I’ll attempt to assess range of motion, deformity, swelling and evidence of prior surgery or trauma and a host of other clues relating to the problem. I won’t try to cause pain, but if you have arthritis, typically joint motion is uncomfortable, especially at the extremes of motion. I’ll observe your expressions, and ask about discomfort. Some of the exam maneuvers are classic hints at the problem. If you’re nervous please tell me; know that I attempt to be as gentle as possible.

Imaging:

In my line of work, x-rays are the most valuable type of imaging, by a long measure. There are many forms of arthritis or disease affecting joints and they all typically end in the loss of articular cartilage. When complete loss of cartilage occurs, the bones of the joint will frequently be touching. We call this bone-on-bone. Occasionally there will be evidence of arthritis such as bone spurs, or erosions and deformity, or shortening of the limb. I’ll share imaging and point this out to you so you can understand your particular diagnosis and the severity.