Does your body give you warning signs? What no one says about the musculoskeletal system
That thigh strain that "will pass". That heel pain that only appears when you get up. That shoulder discomfort you've been carrying for months without telling anyone. Millions of people—athletes and non-athletes—live with these signs without paying them any attention, until a minor injury becomes a chronic injury.
In the third episode of Medicina Sin Filtro, Dr. Nicolás Bernard—an Argentine radiologist, musculoskeletal imaging subspecialist, and imaging consultant for the Argentine Handball Confederation, now based in Tunja, Colombia—frankly explains the most common mistakes when diagnosing muscle, tendon, and bone injuries, and why time is the most underestimated resource in an athlete's recovery.
Key Topics of the Episode
The mistake that costs the most: not knowing what you're looking for
When thinking about medical errors, one imagines a lack of technical skill. But according to Dr. Bernard, the most frequent cause of a misdiagnosis in musculoskeletal ultrasound is another: not asking the right clinical questions before applying the transducer. How the injury happened, when it happened, and exactly where it hurts—pointed out with a fingertip, not the whole hand—are the data that guide an accurate study.
Without that approach, any specialist, no matter how experienced, can overlook the relevant finding. And in the world of sports, every day of delay is one less day of rehabilitation.
The invisible tear: the case of the soleus
One of the most compelling examples in the episode is the injury of the soleus muscle—the same one that has kept players like Gareth Bale off the field. Unlike a classic tear, this injury does not announce itself with a sharp sting: it develops gradually, the player thinks it "has passed" after a day or two of rest, and relapses upon returning to play.
The most surprising fact: up to 70% of soleus tears are not detected by ultrasound, due to the complexity of its myoneurotic junctions. When clinical suspicion is high and ultrasound shows nothing, the next mandatory step is an MRI.
Ultrasound, X-ray, or MRI: which to use and when
The episode offers a clear guide on when to order each imaging study:
- X-ray → suspected bone, neoplastic, or tumor injury. It is irreplaceable for viewing the bone structure.
- Ultrasound → superficial soft tissue injuries: muscle tears, accessible ligament strains.
- MRI → deep joint injuries—cruciate ligaments, menisci—where ultrasound and X-ray "fall short".
The corticosteroid story that almost cost him his fellowship
One of the most honest anecdotes in the episode: while a fellow, Dr. Bernard injected a patient's shoulder with corticosteroids who could not sleep due to the pain, without consulting his superior beforehand. The patient improved immediately. But the lesson he learned was another: the use of corticosteroids without proper precaution can have a harmful effect on tendons in the medium term. Immediate relief is not always the safest decision.
Overdiagnosis: the epicondylitis myth
Not all elbow pain is "tennis elbow". Dr. Bernard explains that epicondylitis—actually epicondylosis, because the tendon degenerates instead of becoming inflamed—is one of the most overdiagnosed conditions. When the image of the tendon looks normal, you have to keep looking: posterolateral elbow instability or radial nerve entrapment are causes that are often overlooked.
- Acute muscle pain after a mechanism of acceleration, braking, or direct impact
- Discomfort that "improves" with rest but reappears as soon as activity is resumed
- Joint pain with a feeling of instability (knee, ankle, shoulder)
- Persistent pain in the heel or sole of the foot, especially when getting up
- Any sports injury that does not resolve in the expected time (2-4 weeks)
Toolkit: how to protect yourself from a misdiagnosis
Practical recommendations left by the episode, both for patients and for colleagues in training:
There is one idea that runs through the entire episode: an accurate diagnosis does not depend on a single study or a single person, but on a team that asks the right questions and a patient who trusts enough to tell exactly what they feel—without hiding anything for fear of missing the next game.
Your body has been warning you for a while. The difference is whether someone—you, your doctor, your team—is knowing how to listen to the signal on time.
Note: this content is educational and does not replace a medical consultation.
