Modern Medicine

Game-changing care for addressing musculoskeletal pain

Choosing the Right
Treatment for Pain

Game-changing care provides patients with more options for addressing musculoskeletal pain

Maybe your ACL is torn, or your elbow injury is interfering with your golf game. You know you need help and that treatment may be time-consuming and costly.

Accurately diagnosing the source of pain caused by musculoskeletal injuries can be complicated. Elbow pain, for instance, could be caused by any one of a variety of injuries. So for Dr. Hollis Potter, chair of the Department of Radiology and Imaging at Hospital for Special Surgery (HSS) in New York, diagnosing a patient’s injury involves intricate detective work. The pursuit of pain has been her life’s work.

“We're solving a problem, solving a puzzle,” says Potter. “If you come in with shoulder pain, my role in your care is to figure it out and show the surgeon or your clinician exactly what's wrong with your shoulder.”

Medical sleuthing helps determine the best surgical approaches to an injury. “What I'm trying to avoid,” says Potter, “is your surgeon in the recovery room looking at his shoes and saying, 'I'm really sorry, but we didn't expect to find this and I had to do another operation.' And suddenly you're faced with a very different rehab that you didn't expect.”

Sometimes the right solution is not to fix. According to Dr. Todd Albert, surgeon-in-chief and medical director at HSS, often a patient's first impulse is to ask for corrective surgery to resolve a musculoskeletal problem. But detailed MR imaging can show when a less invasive treatment, such as physical therapy obviates the need for surgery.

“I always say to patients, you can always do surgery, but you can't very easily undo surgery,” says Albert. “The cost of having a wrong spine surgery may lead to another and another, and that's an enormous cost. Getting the right diagnosis the first time leads to a lot of efficiency, value and the correct treatment the first time.”

Changing the Game

Since Potter's career began in 1990, imaging technology has advanced dramatically, leading to better patient care and more efficient diagnostics. She’s been at the forefront of that evolution.

“People were coming in with pain following joint replacement,” Potter recalls. “The clinicians would go through a standard algorithm of reviewing an x-ray. The x-ray would look great, and they still couldn't explain why the person was uncomfortable.”

In the past, x-rays were the standard for imaging when it came to arthroplasty, or joint replacement. Since most implants were constructed with metal parts, many doctors believed that Magnetic Resonance Imaging, or MRI, would distort the image produced or potentially be unsafe. “It was somewhat heretical to take a big piece of metal inside a patient and put it inside a big magnet,” Potter says.

But Potter was one of the earliest doctors to realize the safety of using MR imaging after joint replacement and prove its efficacy through research.

“We thought about the idea of using MR imaging because it had superior soft-tissue contrast to look at the soft tissues around the artificial joint” she continues. “We not only showed that it was safe but that it provided important clinical information, and now we're funded by the NIH for continued work.” As standard of routine care at HSS, eight to 15 arthroplasty patients per day are scanned in an effort to detect early signs of artificial joint failure. Such early detection would both improve patient outcomes and reduce health care costs by facilitating early treatment.

Driving Value Through Imaging

President and CEO Lou Shapiro agrees that in delivering quality musculoskeletal care, imaging is a crucial component.

“We have technology that's very sophisticated and individuals who are very skilled,” Shapiro says. “The intersection of those two things allow them to help treating physicians see things that you can't otherwise see. That allows the physician to identify the way to start the right treatment.”

Early and accurate diagnoses are integral to providing value, says Dr. Catherine MacLean, chief value medical officer at HSS. “We provide really high quality radiographic and imaging evaluation,” MacLean says. “We're able to detect things that might not have been detected on a low quality study. This facilitates rapid diagnosis and the right treatment.”

Team Effort

But value doesn't happen in a bubble. Dr. Robert Hotchkiss, Medical Director of Innovation at HSS, describes the interplay that his department and the imaging department need to have in order to treat their patients holistically.

“I'll call up Dr. Potter and say, 'I'm having trouble seeing 'x'. Am I missing something in the sequence here?” says Hotchkiss. “And frequently, I'll just go over to her office.” The proximity allows each department to work closely together, share expertise, and greatly minimize patient complications.

The interplay between specialists is common at HSS, and Potter often finds herself volleying between departments to answer questions and put together pieces of a medical puzzle. “Anything to get patients “back in the game,” says Dr. Douglas Padgett, Chief of the Adult Reconstruction and Joint Replacement Service.

“[Potter is] always available for consultation and will often reach out when unexpected findings are noted,” Padgett says. “I can assure my patients they are receiving top-flight comprehensive musculoskeletal care.”

And for Potter, patient care is what it's all about.

“My integration into HSS … came from sitting in the back of an orthopedic conference and just listening to the complaints: If only I could do this. If only I could change that. I saw that it's my role to come in and solve that problem,” she says. “Once we have the clinicians working with the research scientists and imagers, we can actually come up with a customized plan for the patient.” HSS, she says, is “one-stop shopping, but it's also a team effort.”

This page was paid for by HSS | Hospital for Special Surgery. The editorial staff of CNBC had no role in the creation of this page.