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Imaging and Tests

Short of having Superman vision, health care providers have to rely on what the patient tells them and what they can appreciate during physical examinations. They then rely on their knowledge and experience to match the available information to make an intelligent  guess about the problem and thus put together plan to address it.

Many a time, however, we need help. We may need help to find out what the problem is, how bad it is, or what exactly we need to do about it. This is where imaging comes in handy. Various imaging tools are available, and each has its own way of looking through your body and show different aspects of it. Unfortunately, imaging is frequently taken for granted, and many patients assume that getting an x-ray or an MRI would pin-point the problem and that the solution automatically follows. Images are only as good as the person looking at them. They may fail to show the problem, or may point to findings that may not be related to the problem at hand. Even worse, they may give false sense of security if the problem is overlooked or the inappropriate imaging modality is ordered.

Ordering images only helps when they are meant to help make a decision. As such, my approach to imaging is selective, and I order them when I suspect a problem that I need to address or when I want to make sure a serious possibility is absent.

Radiographs (X-rays)

normal wrist

X-rays are the most common and simplest diagnostic imaging technique. A x-ray is always a good start. It is cheap, informative, and available on demand in my office. X-rays are the mainstay tool to look for fractures and arthritis. The down side is that x-rays are not as helpful looking at soft tissue problems, and that they do not show fine details when necessary.

Ultrasound Examination

Ultrasound of the shoulder

Ultrasound relies on sound waves to create an image of your soft tissues the same  way sonar works. It is available in my office, and I rely heavily on it to look at tendon-related problems. It is very useful to make a quick diagnosis and may save you a trip to the MRI suite! I can perform it during the same visit and the best part is that is is interactive- you get to watch me doing it and I can position your arm as needed until we get the right angle.

Computer Tomography (CT ) Scan

scaphoid 3d ct 500scaphoid ct 500

CT scans is an advanced form of X-rays. The images produced look like slices through the structure of interest. They can even be reprocessed to create a 3D model of the injured bone. To obtain the best images possible,  you are asked to lie motionless on the CT scanner table. CT scans help define the details of bony structures. A modern CT scanner is available at our hospital.

 Magnetic resonance imaging (MRI)

PASTA 500

MRI is an advanced imaging tool that produces detailed images of your body. MRI uses magnetic field and does not produce radiation. The images produced look like slices through the structure of interest. To obtain the best images possible,  you are asked to lie motionless on the MR scanner table.The MRI produces high-definition pictures of your bones and, more importantly, the surrounding soft tissues. A modern MRI scanner is available at our hospital. Claustrophobic patients may not tolerate going through the scanner very well. If you are claustrophobic, we can make arrangements to  an open MRI upon request.  MRI may not be safe if you have metal implants, clips, or other metal objects in your body, so it is important to inform us about any of those.

Diagnostic injections

So far, all of the above diagnostic tools take images and try to show abnormalities inside. They, however, do not prove that what shows on the images is truly the problem. This is where diagnostic injections can be very helpful. A well positioned injection loaded with numbing medicine should relief the pain if injected where the problem is. I find this to be very helpful. Usually I mix steroid with the numbing medicine, and as such, I look for two things to happen: immediate pain relief tells me we were on it; prolonged pain relief tells me the problem was solved. So practically, we may hit two birds with one stone!

Nerve Testing

Nerve testing is useful to confirm the diagnosis and help make a decision regarding treatment. During the test, a combination of surface electrodes and thin needles are applied to your arm.  The needles are a little uncomfortable, but worth it. The aim of the test is to find out if there is an interruption in the flow of information along the length of the nerve in question. It helps in determining the extent of the block, approximate location, and roughly how long it has been going on. For example, it can tell us whether the numbness or tingling is caused by a problem in the neck or a pinched nerve in the arm. It also helps monitor nerve recovery when needed.

The accuracy of nerve tests depends on the skill of the person conducting the test and the precision of the equipment used. Additionally, the tests cannot pick up all problems with the nerves. I usually match the interpretation of the nerve test  to your symptoms as well as my examination. If there is a discrepancy, we will have to make a decision regarding who to trust- the clinical findings or the nerve test report?


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