Our Orthopedic Approach

Drs. Irène & Robert Minkowsky are orthopedic medicine practitioners trained in the diagnosis, treatment, and prevention of disorders, injuries and diseases of the musculoskeletal system. We specialize in nonsurgical means to treat painful musculoskeletal conditions, spine disorders and sports injuries, as well as nonsurgical orthopedics.

The musculoskeletal system is very complex and includes joints, ligaments, muscles, tendons nerves and blood vessels, all surrounded by fascia. All elements must be addressed for successful resolution of a problem. As medical doctors, they frequently also use osteopathic approaches and manipulation to treat their patients.

A thorough comprehensive evaluation precedes an individualized treatment program with emphasis on restoration of musculoskeletal balance, control of pain (principally non pharmacologic) and recovery of function. Their success stems from being thorough and methodical in their approach.

The History of Orthopedics

If you develop persistent shoulder or back pain, most people think of consulting an orthopedist. In the United States, orthopedists are surgeons. They define issues on the basis of anatomical change seen on an x-ray or MRI and approach treatment with the goal of restoring “normal” anatomy.

In 1929, a British orthopedist, Dr. James Cyriax, came to the realization that musculoskeletal complaints are often accompanied by normal or equivocal x-ray studies and that a detailed examination of the function of the musculoskeletal system was necessary in order to establish a specific diagnosis and treatment.

Orthopedic Medicine was born.

The goal of orthopedic medicine is to make a precise diagnosis through a detailed physical examination and provide treatment to restore normal function of the musculoskeletal system. It overlaps with the focus of Physical Medicine and Rehabilitation (PM&R), a medical specialty with a focus on improving function.

Everyone develops anatomic structural abnormalities in bones and joints as we age, but they do not necessarily cause pain. In fact, they often help to provide stability. Pain frequently results from impaired function. A spine may look arthritic, but the person may be pain free and active.

More About Nonsurgical Orthopedics

Non-surgical orthopedics is a field of medicine that focuses on the diagnosis, management, and treatment of musculoskeletal conditions without the use of invasive surgical procedures. These conditions may include injuries or disorders that involve bones, joints, ligaments, muscles, tendons, and nerves.

Most medical problems are more complicated than one would think at first glance and are often due to a myriad of factors. Although ostensibly a fall or other injury may be the trigger for symptoms, there are often other issues that lurk in the background rendering the individual susceptible to injury or trauma. It is critical that a detailed history and clinical examination be performed to uncover all the elements that create a medical problem. Today, all too often, total reliance is placed on imaging studies. Although imaging detects structural abnormalities, an individual’s symptoms may be the result of many factors that cannot be visualized in an MRI machine. The single most important element in making an accurate assessment and diagnosis of a patient’s problem is to take a detailed history and then perform a detailed physical examination. 

To illustrate this point, here is a case synopsis.

A healthy 40-year-old woman presented to our office complaining of the recent onset of low back pain that had been progressively getting worse. Visits to an emergency room and to a spine surgeon at a renowned university medical center had failed to provide a diagnosis. She was simply told that she did not have a surgical problem. An interventional spine physician gave her an epidural injection without any benefit. She was then advised to seek help at a chronic pain clinic. Neither doctor took a history, much less examined her, and based their conclusions and treatment approach solely on looking at the MRI of the lumbar spine.

In our office, after a detailed history, the examination revealed that the woman had an obvious limp and could barely bear weight on one leg without producing excruciating pain. The skin of the buttock of her affected leg was red and hot. She was immediately sent to the hospital where a diagnosis of a staph infection in her pelvis was made. The infection had created an abscess in the skin and soft tissue of the buttock. She had septicemia with staph in her blood and required 8 weeks of IV antibiotic therapy for resolution. The point of this case is that the MRI findings were irrelevant to what was occurring and the reliance solely on the MRI as the most important piece of information led to a missed diagnosis that could have cost the patient her life.

At the Physicians’ Back Institute, our doctors use their 35 years of medical practice and experience in orthopedics, rheumatology and neurology to make a precise diagnosis and provide effective nonsurgical treatment of complicated musculoskeletal issues. They understand that images and x-rays are important, but they are only a part of the picture. By combining their experience in Orthopedic Medicine and Physical Medicine and Rehabilitation (PM&R), Drs. Irène and Minkowsky treat the spine and joints as part of the entire body and are able to improve how their patients feel and move. They understand the art of medicine.