Before surgery.
Make sure the treatment matches the problem.
Surgery can be the right answer. The important question is whether it is the right answer for your diagnosis, your goals, and the stage of the problem you are actually dealing with.
A thoughtful decision starts with the right diagnosis.
Good nonsurgical musculoskeletal care should not be anti-surgery. Some problems are best treated with repair, reconstruction, decompression, or replacement. In those situations, delaying the appropriate operation can make the path harder rather than better.
The role of a careful nonsurgical evaluation is to make sure the decision rests on the right diagnosis and that meaningful alternatives have been considered when they are reasonable.
“The goal is not to avoid surgery at all costs. It is to make sure the treatment matches the problem.”
Jeremy Girmann, DO, RMSK
What should be clear before you commit?
Sometimes the best nonsurgical opinion is a surgical referral.
I do not consider a recommendation for surgery a failure of conservative care. When the diagnosis, anatomy, severity, and goals point clearly toward surgery, the useful thing is to recognize that and help the patient move forward intelligently.
Major structural failure
Certain tendon ruptures, unstable injuries, displaced fractures, or other lesions may be better served by repair or reconstruction.
Progressive neurologic compromise
Meaningful progressive weakness or other neurologic deterioration can change the urgency and the appropriate treatment path.
Advanced joint disease
When symptoms and functional loss are severe and nonsurgical options no longer provide acceptable benefit, replacement may be the most predictable solution.
A clear surgical target
When the pathology fits the symptoms and the operation directly addresses the problem, surgery may offer more value than repeated procedures.
Nonsurgical does not mean passive.
There are also situations in which a patient has been told an operation may be next but the clinical picture leaves room for another approach. The exact options depend on the diagnosis.
What patients usually want to know.
Does getting a nonsurgical second opinion mean I should avoid surgery?
No. The purpose is to clarify whether surgery is the treatment that best matches the diagnosis, severity, goals, and available alternatives.
When is surgery clearly the better option?
Examples can include certain unstable injuries, major structural failure, progressive neurologic compromise, advanced joint disease with unacceptable symptoms, or situations where a repair or replacement offers a more predictable benefit than continued nonsurgical care.
Can PRP or BMAC replace surgery?
Sometimes an orthobiologic procedure may be a reasonable nonsurgical option, but it should not be presented as a universal substitute for repair or replacement. The diagnosis and evidence for the specific condition matter.
Where does Dr. Girmann see patients?
Clinical care is provided through Inertia Medical in Greater Cincinnati.
This page is educational and does not establish a physician-patient relationship. Individual treatment recommendations require a clinical evaluation.
Discuss your options.
A clinical evaluation at Inertia Medical is the place to review your diagnosis, previous treatment, and goals.