Symptom, Source, Cause

Addressing Symptom, Source, and Cause:

When a patient comes to our clinic, it is usually to address a symptom. Examples of symptoms include hip pain, shoulder pain, back stiffness, TMJ, and headaches. In other words, all the things that can lead to discomfort and a decreased quality of life. Symptoms offer some useful information. They sometimes tell us the general area of the problem (e.g. the hip), and their characteristics can give us clues as to the source (muscle, nerve, bone, etc.). Most importantly, they set an expectation—improvement correlates with symptom relief.

As physicians, we have tools to ease your symptoms. We may prescribe anti-inflammatories for pain, muscle relaxants for spasms, or even perform injections to provide relief. But it is important that we do not stop there. We need to find the source of the symptom to help guide our treatment plan. For example, pain in the shoulder is the symptom, but the source of that pain could be a muscle strain, bony arthritis, or a ligament tear. If you have a severe ligament tear, you may need surgery, but just a muscle strain is treated more conservatively. Figuring out the source takes us one step closer to correcting the root cause.

The most important, and often most difficult, aspect of a problem is the cause. Returning to the shoulder example, the symptom is shoulder pain, and the source is a muscle strain in the rotator complex. But why was the muscle strained? Sometimes the answer is easy (threw too many pitches at baseball practice), but often the answer is more complicated. A common cause of shoulder muscle strains is dysfunctional movements of the shoulder blade (scapula). The scapula makes up half of your shoulder joint, with the arm bone (humerus) making up the other half. If every time you move your arm, the scapula does not move with it appropriately, then you are going to suffer muscle strains, impingements, bony wear-and-tear, and rotator cuff damage. The end result will be shoulder pain and loss of function.

Putting it all together, the shoulder pain is your symptom, the muscle strain is your source, and poor scapular motion is your cause. The key to correcting musculoskeletal problems is addressing all three. Of course, the cause it the most important, but we cannot ignore the source or the symptoms. Maybe we correct the scapular motion, but a tear in the rotator cuff is too significant to heal on its own. We then must correct the source, usually through regenerative injections like prolotherapy or surgery. Finally, physicians cannot lose sight of what brings patients in to see them in the first place. A patient did not come in for scapular motion problems or muscle strain; they came for shoulder pain. It is important that a complete treatment addresses the symptom, the source, and the cause. Failure to resolve any one of these can lead to failure of the treatment.

Given the complexity of complete treatment for a musculoskeletal problem, it is often best to see a physician who specializes in this area of the body. These include sports medicine, physiatry, and osteopathic musculoskeletal medicine. These specialists have additional training after medical school that emphasizes understanding and treating the musculoskeletal system. They will be able to evaluate your symptom, identify the source, and figure out the cause. They will then work closely with you to develop an individualized treatment plan to help resolve all three.

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