Been told you need an operation? A musculoskeletal second opinion in Málaga — in English

What the second opinion includes

I am not a surgeon. I am a rehabilitation physician, and my value in a second opinion is different: assessing whether reasonable conservative alternatives exist for your problem — and if surgery really is the best option, telling you so clearly. Specifically, the consultation includes:

• A review of the tests and reports you bring: MRI, X-rays, previous ultrasounds and reports from other specialists.
• A full examination: how you move, where exactly it hurts, which structures are involved and how it limits your daily life.
• In-consultation ultrasound where it adds information: it shows tendons, muscles, bursae and joints in motion, to contrast with what the scans say.
• An honest explanation of the conservative alternatives and their limits: therapeutic exercise, ultrasound-guided injections, PRP, hyaluronic acid, hydrodilatation for frozen shoulder, barbotage for calcific tendinitis… Not everything works for everything, and I will also tell you what I do not expect to work in your case.
• And if surgery is the best option, I say so and refer you to the right surgical specialist.

Cases where it tends to be worth asking

Some problems have more than one reasonable path, and the best option depends on your age, your activity, how long you have been in pain and what you have already tried:

• Degenerative meniscus tears: in many cases, depending on age and the state of the joint, conservative treatment is a reasonable alternative.
• Partial rotator cuff tears: not all of them need surgical repair.
• Knee osteoarthritis and the timing of a replacement: when waiting makes sense and what can be done meanwhile.
• Shoulder calcifications: some can be treated at the consultation with ultrasound-guided techniques.
• Frozen shoulder (adhesive capsulitis).
• Stubborn tennis elbow that hasn't responded to the usual measures.
• Chronic plantar fasciitis.
• Low back pain without red flags where an intervention has been proposed.

If you want to see how I think about these decisions, read Injection or surgery?

When this is NOT the path (and you should go to A&E or orthopaedics)

Being honest also means telling you when a conservative assessment is not what you need right now. In these situations, go without delay to the emergency department or to an orthopaedic surgeon:

• Fractures or suspected fractures.
• Acute trauma: a fall, an accident or a sports injury with deformity, major swelling or inability to bear weight.
• Acute joint locking — a knee stuck «caught», unable to straighten or bend.
• Progressive neurological deficit: loss of sensation or strength that keeps getting worse.
• Sudden loss of strength in an arm or a leg.
• Suspected infection (a hot, red joint with fever) or tumour.
• Lumbar red flags: loss of bladder or bowel control, numbness in the genital or perineal area, progressive weakness in the legs.

In those cases, the surgical specialist and the emergency services should see you first. My role, if any, comes later: in the recovery.

How to prepare for the consultation

• Bring your reports and scans (printed, on CD or with digital access): MRIs, X-rays, ultrasounds, consultation or A&E reports.
• A list of the treatments you have already tried: physiotherapy, medication, injections, insoles… for how long and with what result.
• Your questions written down: what worries you, what you have been told, and what you need to be able to do again.
• Comfortable clothing that allows the area to be examined.

My goal is for you to leave the consultation with a clear plan in writing or specific instructions: what we are going to do, in what order, what to expect and when we review.

Orthopaedic surgeon or rehabilitation doctor for a second opinion?

Both options are valid and often complementary. Orthopaedic surgery diagnoses and treats — also conservatively — and is especially relevant for fractures, acute trauma, structural problems and when surgery is on the table. Physical Medicine & Rehabilitation is oriented to recovering function, managing pain and reasonably exhausting non-surgical treatment: therapeutic exercise, ultrasound-guided techniques and a recovery plan.

A second opinion from my specialty brings that perspective: what function you can recover without an operation, and what you cannot. If your goal is to assess the problem and explore non-surgical options first, the specialist you are looking for may be a rehabilitation physician. I work in coordination with orthopaedic surgeons and, when surgery is the best option, they are exactly who I refer you to. More on this in Orthopaedic surgeon or rehabilitation doctor?

Where I see patients

I see patients at clinics across Málaga and the Costa del Sol — see clinics and phone numbers for addresses, or book directly on Doctoralia. If you are already in physiotherapy, you may also want to read how I work with physiotherapists.