Diagnosis, the basis for determination of treatment, is defined as “the art or act of recognizing the presence of disease from its signs or symptoms”. Diagnostic tools help you uncover or establish the characteristics of the disease(s) or condition(s). Chiropractors have a wide range of diagnostic tools available to them today …from the old stand by’s to newer technologies. New procedures, tests and technologies continue to be developed, some complementing diagnostic tools of long standing and some replacing them.
The most advantage is gained in determining the appropriate procedure when you know the type of information to expect. Additional benefits come from the documentation of the findings and application to the treatment plan…the ultimate goal of diagnosis.
X-Ray’s: The plain film radiograph of the spine is still considered the simplest and most common diagnostic tool used by doctors to evaluate skeletal problems. X-rays can gather an astonishing amount of necessary information about the patient. Above and beyond ruling out pathologies and possible fractures, X-rays can be used to show mensuration lines that can be used to determine and document specific structural impairments. X-ray’s are the basis for documentation of structural and spinal abnormalities.
MRI: Developed in the 1980’s, Magnetic Resonance Imaging (MRI) produces images of the anatomy without the use of radiation, as in X-ray and CT scanning. An MRI scan, with its enhanced image resolution, can be an extremely accurate method of disease detection throughout the body and is most particularly useful when considering problems associated with the vertebrae or intervertebral discs of the spine. An additional benefit is that an MRI is a non-invasive procedure, and there are no known side- or after-effects.
Typical MRI results of the spine can provide information such as spinal alignment, disc height and hydration, configuration of vertebral bodies, the appearance of intervertebral discs—normal, bulging, herniated, dehydrated or degenerated, the size and appearance of the spinal canal—compression of cord or nerve root, and other abnormalities or inflammation. An MRI cannot distinguish between painful and non-painful anatomical problems in the spine. The patient’s physical exam and symptoms must be correlated with the MRI findings to arrive at a clinical diagnosis.
CT Scan: Computerized (Axial) Tomography, often referred to as “CAT” scans, has been described as a fancy X-ray that can take cross-section (axial) images of the body. They are extremely useful for assessing fractures, because of the bony detail provided. Nerve roots, however, are not clearly shown and smaller disc herniations can be missed. The highly invasive combination procedure of a CT scan combined with a myelogram is a very sensitive test for nerve impingement. A CT scan is a diagnostic alternative for patients who are not candidates for an MRI because of the presence of a pacemaker, metal slivers in eye, aneurysm clip in brain, etc.
Musculoskeletal Ultrasound: Musculoskeletal ultrasound scans of the spine and extremities can provide differentiation of soft tissue, including ligaments, tendons, nerve root area, facet area, costovertebral junction and muscle spasms, for evaluation and documentation. Extremities, such as shoulders, knees, ankles, hips, wrists and elbows, can be imaged and reviewed. Ultrasound allows for real-time scanning of moving and static soft-tissue structures, an important consideration in injuries such as rotator cuff. One limitation is that ultrasound does not pass through bone, so some soft tissue areas cannot be imaged. It is excellent, however, for imaging soft tissue and documenting trauma to tendons, tendonitis, tears, inflammation and ruptures, ligament strains and tears; injury or rupture of muscles, bursitis, capsulitis, neuromas, fibromas and cysts. Musculoskeletal ultrasound is a very “patient friendly” procedure, and there are no known side- or after-effects to its use.
Videofluoroscopy (VF): The American Chiropractic College of Radiology has stated that videofluoroscopy is a useful imaging modality for the demonstration of spinal intersegmental joint dysfunction. VF can display the abnormal motion of the cervical spine, showing the point in motion the hypermobility or aberrant motion occurs. VF is valuable in detecting instability in flexion and extension not otherwise visualized or detected on plain films. VF can be used to document hypermobility, hypomobility, aberrant motion, instability, aberrant coupling, paradoxical motion and evaluation of spinal arthrodesis. Videofluoroscopy is an X-ray procedure and, as such, is contraindicated during pregnancy. Some other contraindications are when motion would be detrimental to the patient; restrictive muscle spasm, dislocations, recent fractures and severe neurological deficit.
Consultation & Physical Exam: The most important diagnostic tool available in your practice is you. Diagnostic tests and procedures can provide targeted information about anatomical regions, physiological systems and more. Your training, and the examination and diagnostic skills you employ enable you, as a chiropractor, to take the best advantage of the data produced by these other tools. Your expertise is required to correlate the assembled findings and determine the best course of treatment for your patient.
Ms. Plank has an extensive background in medical and facilities management. Before making the transition to healthcare, for over 10 years she was the Practice Manager for a large veterinary hospital and a “first of its kind” commercial veterinary blood analysis laboratory. During the past 15 years, Ms. Plank has provided technical and management services to healthcare providers, specializing in radiology and neurology. She is currently the Vice President of Corporate Services for Practice Perfect. Contact her at [email protected].