Recognizing underdiagnosed orthopaedic conditions early can make a significant difference in patient outcomes. Many of these conditions present with subtle symptoms or mimic more common injuries, making them easy to overlook. These diagnostic pitfalls can delay treatment, leading to prolonged pain, loss of function, and, in some cases, permanent damage. Greater awareness of underdiagnosed orthopaedic conditions can help you recognize these problems earlier. By understanding which injuries are commonly missed and why they go undetected, you can refine your diagnostic approach and ensure patients receive timely, appropriate treatment.
Underdiagnosed orthopaedic conditions
Identifying commonly overlooked orthopaedic conditions is essential for preventing delayed diagnoses and ensuring patients receive the care they need. Here is a list of known orthopaedic conditions that are frequently missed during initial evaluations.
- Achilles tendon ruptures 2, 5
- Anterior cruciate ligament tears 6, 7
- Frozen shoulder 1
- Femoral neck stress fractures 3, 6
- Hourglass constrictive neuropathy 4
- Posterior tibial tendon dysfunction 1
- Scaphoid fractures 5, 6
- Slipped capital femoral epiphysis 6
- Ulnar collateral ligament tears 6, 7
The significance of recognizing underdiagnosed orthopaedic conditions
As an orthopaedic professional, you encounter patients with musculoskeletal pain every day. Some diagnoses are straightforward, but others are easy to miss. Certain injuries and conditions present with subtle symptoms or mimic less severe issues, leading to delays in treatment. You might see patients who have been misdiagnosed elsewhere or whose conditions have worsened due to prolonged uncertainty. When these cases slip through the cracks, patients suffer unnecessary pain, loss of function, and, in some cases, permanent damage.5, 6
When these cases slip through the cracks, patients suffer unnecessary pain, loss of function, and, in some cases, permanent damage.
One of the main reasons certain injuries are overlooked is that they do not always fit the classic presentation seen in textbooks. For example, patients with Achilles tendon ruptures may not exhibit significant swelling, leading you to mistake the injury for a simple calf strain.2 Likewise, an adolescent with slipped capital femoral epiphysis may report only knee pain, diverting attention away from the underlying hip pathology.6 Scaphoid fractures frequently appear normal on initial radiographs, tempting clinicians to dismiss them as wrist sprains.5, 6 These diagnostic pitfalls can have lasting consequences if not recognized early.
Why some conditions are easily overlooked
Several factors contribute to missed orthopaedic diagnoses. One is the reliance on imaging without strong clinical suspicion. While X-rays, MRIs, and CT scans are valuable tools, they are not always definitive. A scaphoid fracture may not become apparent on X-rays until 10 to 14 days after injury.5, 6 A ligament injury like a UCL tear or ACL rupture might not be immediately obvious if only standard radiographs are obtained.6, 7 In cases like hourglass constrictive neuropathy, imaging alone is often insufficient, requiring high-resolution ultrasound or specialized nerve studies for detection.4
Without a detailed patient history and a focused clinical exam, it is easy to attribute symptoms to the wrong diagnosis.
Another challenge is symptom overlap. Many musculoskeletal conditions share common features, such as pain, swelling, and limited mobility. Without a detailed patient history and a focused clinical exam, it is easy to attribute symptoms to the wrong diagnosis. A patient with frozen shoulder may be assumed to have impingement syndrome, delaying appropriate intervention.1 A young athlete with a femoral neck stress fracture may initially be treated for a hip flexor strain, putting them at risk for serious complications like displacement or avascular necrosis.3, 6
The consequences of delayed diagnosis
Missed diagnoses prolong discomfort and can lead to permanent functional impairment. A scaphoid fracture that is not properly immobilized can progress to nonunion, resulting in early arthritis and chronic wrist pain.5 An undiagnosed PTTD can lead to progressive flatfoot deformity, requiring invasive surgical correction instead of simple orthotic intervention.1 ACL tears that are not identified early can lead to secondary meniscus and cartilage damage, increasing the risk of osteoarthritis.6, 7
Missed diagnoses prolong discomfort and can lead to permanent functional impairment.
In sports medicine, missing a key diagnosis can be career-altering for athletes. A UCL tear in a baseball pitcher, if not recognized in time, can lead to chronic elbow instability and an increased risk of secondary injuries.6, 7 Similarly, a misdiagnosed femoral neck stress fracture in a runner can worsen with continued weight-bearing, necessitating surgical fixation instead of conservative treatment.3
Beyond the physical consequences, delayed diagnoses can also lead to frustration, lost time, and unnecessary medical costs for patients. Many individuals with persistent pain undergo multiple consultations before receiving the correct diagnosis, leading to prolonged suffering and a decline in their quality of life.5
Improving diagnostic accuracy
Recognizing underdiagnosed orthopaedic conditions requires a combination of clinical vigilance, thorough examination techniques, and appropriate use of diagnostic tools. Clinical tests remain invaluable. Special maneuvers like the Lachman’s test for ACL tears and the Thompson test for Achilles ruptures can provide immediate diagnostic clues.2, 6, 7 If an injury mechanism or patient history raises suspicion, imaging should be used judiciously, with repeat studies or advanced modalities when necessary.6
Recognizing underdiagnosed orthopaedic conditions requires a combination of clinical vigilance, thorough examination techniques, and appropriate use of diagnostic tools.
Equally important is a strong emphasis on patient history. Many conditions have telltale descriptions that can guide your evaluation. A patient with an Achilles rupture might describe the sensation of being “kicked” in the back of the leg, while an individual with SCFE may walk with external rotation of the hip.2, 6 Recognizing these key details can prevent misdiagnosis and guide appropriate management.
The impact of early recognition
When underdiagnosed conditions are identified early, treatment outcomes improve significantly. Immobilizing a scaphoid fracture before it progresses to nonunion can prevent long-term wrist dysfunction.5 Catching an ACL tear before additional knee damage occurs allows for better surgical planning and rehabilitation.6 And detecting PTTD in its early stages enables nonoperative management with orthotics and physical therapy, avoiding the need for reconstructive surgery.1
When underdiagnosed conditions are identified early, treatment outcomes improve significantly.
In addition, proper diagnosis fosters patient confidence and satisfaction. Many individuals with chronic pain feel unheard after repeated misdiagnoses. By considering less common conditions and taking the time to perform a comprehensive evaluation, you can provide reassurance and clarity for patients who have struggled to find answers.5
Recognizing underdiagnosed orthopaedic conditions can make a significant difference in patient outcomes. Many of these conditions are subtle, mimicking more common injuries or appearing normal on initial imaging. However, catching these conditions early can provide the treatment patients need before complications arise.6
Actionable steps for improving diagnosis
Recognizing underdiagnosed orthopaedic conditions requires a proactive approach in both clinical evaluation and patient management. By refining your diagnostic techniques and staying aware of commonly missed injuries, you can improve patient outcomes and prevent complications. Here are some key steps to enhance diagnostic accuracy:
- Take a thorough patient history
- Perform targeted physical exams
- Consider advanced imaging when necessary
- Look beyond the obvious diagnosis
- Educate patients on warning signs
- Stay updated on emerging research
The provided list is not exhaustive, and ongoing learning is key to improving diagnostic accuracy. But, by incorporating these steps into daily practice, you can improve early detection of underdiagnosed orthopaedic conditions and ensure patients receive timely, effective treatment.
Sources
- Causes and Cures: The Most Common and Commonly Unknown Orthopaedic Conditions
- Commonly Missed Orthopedic Problems
- Hourglass Constrictive Neuropathy: A Likely Underdiagnosed Condition with Characteristic Imaging Features
- Misdiagnosis and underdiagnosis of multiple sclerosis: A systematic review and meta-analysis
- The Number of Misdiagnosed Orthopedic Injuries in the ER Will Shock You!
- The Orthopedic Upper Extremity Surgeon’s Role in the Diagnosis and Treatment of Osteoporosis: Making Use of Opportunistic Imaging
- Traumatic brain injury is common and undertreated in the orthopaedic trauma population
