Diagnostic Studies
Diagnostic studies or tests are not “routinely” necessary for most of our patient’s episodes of acute musculoskeletal injuries. Obtaining a comprehensive medical history and a thorough physical examination often provide the primary indicators of the real problem. Therefore, here at FORMA, the main purpose of our diagnostic tests is to confirm suspicions of the cause of the problem or to rule out serious underlying structural, pathologic conditions.
As you can imagine, we apply careful and selective criteria to determine the usefulness of our diagnostic examinations. At FORMA, in-office diagnostic studies are performed when clinically indicated after a determination by a physician, and can include fluoroscopy (x-rays), electrodiagnostic studies (EMG/NCS) and musculoskeletal ultrasound, each of which is described in detail below.
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Electrodiagnostic studies are important diagnostic evaluations of several conditions where nerves and muscles are involved. These studies — including nerve conduction studies (NCS) and electromyography (EMG) — are used to measure nerve-conduction velocity (NCV) and muscle-action potential. If that sounds confusing or complicated, just know this: These tests determine if symptoms (e.g., weakness, unresolved numbness or nerve pain in the legs or arms) are caused by a disorder of the nerve supply or the muscle fiber.
At FORMA, these types of tests can establish what nerve is pinched, and where the impingement is, confirming the image (MRI or CT Scan) findings. In addition, electrodiagnostic testing will give a measurable value to how severely it is affected and if the injury (denervation) is healed (chronic) or ongoing (active).
Measuring the electrical activity in muscles and nerves can also help us identify diseases that could damage muscle tissue or nerves. They are also helpful in excluding other causes of sensory and motor disturbances, such as peripheral neuropathy and motor neuron disease, and are sometimes used to diagnosis neck and shoulder pain, arm pain, numbness and tingling.
EMG and nerve-conduction studies are often performed together to provide more complete information. This information can then be used to help the FORMA medical and treatment team formulate further treatment plans.
An electromyogram (EMG) measures the electrical activity of muscles at rest and during contraction. During the EMG portion of the test, your FORMA doctor places small (acupuncture-like) needles into select muscles in the arm or leg to record specific electrical signals from each muscle. A muscle doesn’t broadcast normal electrical responses if it doesn’t receive adequate signals from a sick nerve, or if the muscle itself is sick.
A nerve-conduction study (NCS) is a test commonly used to evaluate the function — especially the ability of electrical conduction — of the motor and sensory nerves of the human body. Nerve-conduction velocity (NCV), which is a common measurement made during this test, is used mainly for evaluation of damage to the peripheral nervous system, (i.e., numbness, tingling, burning and/or weakness of the arms and leg), which includes all the nerves that lead away from the brain and spinal cord and the smaller nerves that branch out from those nerves.
Some of the common disorders that can be diagnosed with the help of nerve conduction studies are:
- Peripheral neuropathy
- Carpal tunnel syndrome
- Tarsal tunnel syndrome
- Thoracic outlet syndrome
- Ulnar neuropathy
- Guillain-Barré syndrome
- Facioscapulohumeral muscular dystrophy
- Plexopathies
- Other entrapment injuries and neuropathies.
To prepare for these types of tests, if possible, prior to your test, shower with a neutral soap and do not apply skin lotion. Certain medicines that act on the nervous system (such as muscle relaxants and anti-cholinergics) can change the results of your EMG/NCS. You may need to stop taking these medicines three to six days before the test. If you take blood thinners, talk with your doctor and find out if you need to stop taking them before the test. Also, be sure to tell your doctor if you have a pacemaker. Do not smoke for three hours before the test. Do not eat or drink foods that contain caffeine (such as coffee, tea, cola, and chocolate) for two to three hours before the test. Wear loose-fitting clothing so your muscles and nerves can be tested. You may be given a hospital gown to wear.
Ultrasound imaging is a non-invasive medical test that helps FORMA’s medical staff diagnose and treat medical conditions right in the office, delivering immediate information to you and to the rehabilitation team. Unlike x-rays, ultrasound exams do not use radiation.
Ultrasound imaging — also called ultrasound scanning or sonography — involves scanning part of your body using sound waves to produce pictures of the inside of the body. Because ultrasound images are captured in real-time, they can show structure and movement, such as the shoulder tendon gliding under the impingement site or the wrist nerve being compress at different positions of the wrist. Ultrasound also can image blood flowing through blood vessels.
Ultrasound images of the musculoskeletal system provide pictures of muscles, tendons, ligaments, joints and soft tissue throughout the body. At FORMA, our medical and rehabilitation team members use ultrasound systems to:
- Detect joint swelling and cartilage damage
- Evaluate and differentiate between acute and chronic tendon and ligament injuries.
Fluoroscopy is a special type of x-ray used to project live images onto a monitor, and is commonly used by our medical team to obtain real-time images of the internal bony structures.
With fluoroscopy x-rays, we always use the lowest dose rates during procedures. The C-Arm Fluoroscope at FORMA provides the ability to reposition the fluoroscope (not you — the patient) to obtain the best guidance in multiple planes.
Most fluoroscopic procedures would likely require contrast dye to highlight a particular target area of the body (such the epidural space) to confirm the dispersion pattern prior to the injection of the intended medication. Our patients with iodine allergy (including shellfish intolerance) should discuss the risks and benefits of using contrast prior to their procedures. Pregnancy is a contraindication to x-ray radiation. Thus, fluoroscopy and CT scans are also contraindicated outside of carefully considered and emergency situations.
Having image guidance allows not only precision in many procedures, but the ability to use the thinnest needle available. This reduces post-procedure soreness and increases safety by allowing direct visualization.
For more information about Diagnostic Studies available in our Costa Mesa, California, office, call us at (949) 999-0777, or send us a message using our Contact page.
