I think a broken bone, or a reasonable possibility of a broken bone, or suspicion of cancer, are excellent reasons for an X-ray. But I refuse to believe an orthopedic can't tell the difference between a broken bone or fracture and soft tissue trauma. At some point during the physical examination, they know. It's not like they don't know, and they need to eliminate possibilities to whittle them down to reveal the problem, otherwise hidden from their eyes and mind. They know. And yet, we'll order $2000 worth of X-rays just to be sure the damn machine gets paid for.

This is not my experience. I've seen a lot of borderline cases where the doctors don't really know if there's a minor fracture or if it's just a partially torn ligament. Typically these are hairline fractures, but it's still valuable to know that it's there to ensure the patient protects the bone until it's healed.

My, admittedly, personal anecdote is a torn rotator cuff caused by an identifiable injury, for no reason, reaching across to shut the passenger door with the wrong arm awkwardly and pulling against the weight too hard too fast, immediately knew there was a problem, right then called orthopedic office assoc. w/ hospital, on its campus, first I made very sure they took my insurance, was assured no treatment would not be covered. They squeezed me in 6 weeks later, saw the doctor and explained what happened. I was in a lot of pain the whole time, basically crippled and one armed. I knew I was looking forward to maybe a year of recovery before the pain really went away. I complained about the pain, but I asked about a cortisone injection. He said he wanted to X-ray the area. I still don't understand why, and he wouldn't say, I thought stubbornly, but I was in pain and irritable. I told him I didn't want the X-ray. He said he wouldn't treat me without the X-ray, and directed me to physiotherapy, which was $1000 and not covered, and they sent me a $125 bill for the visit. Took a year and a half before my arm was 100%

Few years later, no recent associated injury with right forearm, but maybe something decades ago, as a child, someone squeezed my wrist way too tight. One day 45 years later, no action or movement, sitting upright, reaching for the wheel, I feel something, idk, muscle, ligament, I do not know, told different orthopedic in the same office it felt like rubber band stretching from my wrist area to my elbow had snapped, and for the next 5 hours I could feel it snaking down my forearm as the elastic whatever relaxed, not painfully at first but then the weirdest burning scraping sensation, in a linear path slowly from elbow to wrist, I thought an elastic slowly being pulled back to where it was still anchored on one end. While it was occurring, I wondered if I was experiencing an extremely slow stroke and was feeling the blood clot drag through a path of veins in my arm. Until, unexpectedly, when the sensation finally got to my wrist, it suddenly sped up, encircled my wrist really fast, and my wrist and hand swelled suddenly in less than a second... while I was staring right at it doing nothing but wondering what was happening. This time, I acquiesces to the X-ray. Orthopedic said it didn't show anything, and maddeningly did not give me any explanation for what had happened to me. Insurance covered the $2000 in X-rays. And they sent me another $125 bill for the visit. Hand useless for a few months.

Latest thing is sprained or strained my left wrist, I think just repetitive injury. It's coming along. I don't see the need to pay $125 and see my insurance milked another $2000 to learn nothing and not be treated.

I also just want to lament that thanks to Sacklers' Oxycontin, gone are the days of getting a week or two of Vicodin or Hydrocodone for some absolutely appropriate pain management for injuries like these. Sucks. That constant pain is maddening, an OTC painkillers just don't have the ability to quite restore sanity. But cannabis helps not care about the pain, thank goodness.