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management fails. Nonoperative management is as effective as surgical management in pain relief and is advised for 3 to 6 months before operative treatment. Focused history and physical examination is the most crucial initial step in the diagnostic process, with supplemental imaging used to assess for structural etiologies when nonoperative management fails. Nonoperative management is as effective as surgical management in pain relief and is advised for 3 to 6 months before operative treatment.The addition of the methyl-7-guano