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Conservative treatment and surgery by diagnosis
| Diagnosis | Usually starts with | When surgery is discussed |
|---|---|---|
| Disc herniation with leg pain | Medication, exercise therapy, injections if needed; in many people pain settles within 6–12 weeks | Increasing leg weakness, no improvement after 6–12 weeks; urgently with bladder problems |
| Degenerative meniscus tear | Exercise and load management | Locked knee; in a worn meniscus arthroscopy is usually no better than exercise |
| Acute meniscus tear in young people | MRI assessment | Meniscus repair is often discussed |
| Knee or hip osteoarthritis | Weight loss, exercise, medication, injections | Severe osteoarthritis with constant pain that limits life despite treatment |
| Spinal stenosis | Exercise, medication, injections | Walking limited by pain and numbness, neurological deficits |
| Rotator cuff tear | Degenerative tear — exercise | Acute full tear in an active patient, arm weakness |
| ACL tear | Rehabilitation | Knee instability, pivoting sports, associated injuries |
When not to wait
- Bladder problems or numbness in the saddle area with back pain — urgent care is needed.
- Rapidly increasing weakness in an arm or leg.
- Fracture, dislocation, locked joint.
- Pain with fever, redness and joint swelling.
If surgery has been offered and there are no urgent signs, there is time for a second opinion. We send your images to several clinics and help you compare their recommendations.
Scientific evidence
Studies this comparison is based on:
- Peul WC et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med, 2007.
- Sihvonen R et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med, 2013.
- Skou ST et al. A randomized, controlled trial of total knee replacement. N Engl J Med, 2015.
Frequently asked questions about treatment or surgery
If the pain is severe, does that mean surgery?
Not necessarily. Pain intensity alone does not decide it — images, neurological signs and the course of treatment matter.
How long should conservative treatment be tried?
Usually 6–12 weeks, longer in osteoarthritis. It depends on the diagnosis and how symptoms change.
Will it be too late for surgery later?
For most conditions, no. Exceptions are increasing weakness, bladder or bowel problems and some acute injuries.
Can injections replace surgery?
Sometimes they help through a period of treatment, but where surgery is really needed injections do not replace it.
How can RegenPAS help?
RegenPAS is a patient service centre in Munich, not a clinic. We review your images and symptoms and send a request to several partner clinics at once. Clinics that can accept you send their own conditions and price; prices differ between clinics, and you choose the option that suits you. The coordinator replies within 24 hours, and a clinic physician’s preliminary opinion follows in 1–3 business days. We then arrange the appointment, visa invitation, interpreter, transfers and accommodation. Treatment decisions are made by the clinic physician. Contact a coordinator.
Have you been offered surgery? Send your images — we will get opinions from several clinics
Send your MRI or ultrasound and describe where and when it hurts. The coordinator replies within 24 hours; a clinic physician gives an opinion in 1–3 business days.
Send images