How We Diagnose the Source of Your Pain
We utilize a combination of approaches to accurately diagnose the source of your pain. These approaches include:
- History of onset, prior treatment, and symptoms – this discussion is important in giving your provider clues as to the source of your pain. For example, if you have complaint of numbness and tingling in your hands, this could point to Carpal Tunnel Syndrome (CTS) versus a pinched nerve in your neck (cervical radiculopathy). Knowing if it happens primarily at night and involves all your fingers points towards CTS.
- Detailed, hands-on physical examination – this is very important because it can help isolate areas of reduced sensation, reflexes, or pain with particular movements. All these pieces are vital in determining an accurate diagnosis.
- Imaging, including x-ray, MRI, CT scans, ultrasound, or others – Different forms of imaging have different strengths.
- Xray is good at showing alignment of the spine, dynamic instability of the spine or other joints, as well as being informative as to the degree of degenerative change that may be present.
- CT scans show very clear bone detail such as the details of bony fractures, tumors or other growths, or integrity of a surgical fusion.
- MRIs are excellent at showing soft tissues such as tendons, cartilage, bone swelling or stress fractures, excess fluid within joints or other tissues, or spinal disc herniations, bone spurs or other causes of pinched nerves.
- EMG/NCV (electromyography/nerve conduction velocity studies) – these studies are performed by Dr. Bainbridge or Dr. Trainor to determine the health of your nerves. These consist of two main parts. The nerve conduction portion of the study involves a small shock applied to the nerves to see how well they are sending signals, whether there is any slowing at a pinch point, and how healthy those nerves are with respect to size of response, speed of conduction and other details. The second part involves a needle placed into the muscles to read the electrical activity of the muscles (electromyography-EMG) The EMG portion of the study can determine if there is evidence of nerve injury to a particular muscle or group of muscles. The pattern of injury within each muscle as well as which muscles are affected can help pinpoint the area of injury to a single or multiple nerves. Diagnoses such as peripheral neuropathy, entrapment neuropathy at the wrist such as carpal tunnel syndrome, or pinched nerves in the neck or low back pinched nerves can be evaluated. This can be very helpful in directing specific treatment, such as therapeutic injections or surgical intervention vs. certain forms of conservative care.
- Fluoroscopically-guided and ultrasound-guided spine, nerve, and joint injections– Injections are often thought of as being part of the therapeutic treatment plan. Injections can, however, be a very important diagnostic tool. Injecting numbing medication into a joint, around a nerve, or in other specific tissue areas can help determine if that targeted site is the source of pain. For example, numbing the small nerve branches (medial branches) to a facet joint of the spine and having that pain go away while those nerves are numb, is an indicator that this in fact is where the neck, middle or low back pain is arising from. This can lead to more specific physical therapies and also lead to therapeutic procedures such as the destruction of those medial branch nerves through radiofrequency ablation.
- Discography is a way to determine if one or more discs of the neck, middle or low back are the source of pain. This is a refined and technical procedure where contrast is injected into the discs, looking at the structure of the discs, but more importantly, any pain response related to placing contrast die in the discs. This can be helpful for planning regenerative medicine disc injections or surgical intervention.
Similarly, if you choose to see our Physical Therapy team first, or in combination with other care, your physical therapist will perform joint and muscle function evaluations to establish your baseline and reassess your progress after you have completed the recommended number of sessions.
Your provider will also perform an assessment during your history to assess whether aggravators of pain such as insomnia or depression may be contributing to your symptoms and may recommend addressing them as part of the comprehensive care we offer at the Denver Spine and Pain Institute.