Diagnosing Disc Problems

A physician’s medical diagnosis (also known as a “clinical diagnosis”) focuses on determining the cause of a patient’s back pain, neck pain or other symptoms. There are three steps to arriving at a clinical diagnosis for a pinched nerve or disc pain:

1. Medical History. A complete review of symptoms will include the location of the pain, a description of how the pain feels, and whether certain activities, positions or treatments make the pain feel better or worse. A full medical background is important to rule out (or identify) other possible conditions that may cause the patient’s pain and will include information such as any recurring health problems, previous diagnoses, past treatments and surgeries, reactions to those treatments, current medications, family history of illness, and any other health concerns.
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2. Physical examination. Depending on the patient’s symptoms, a physical exam may include one or more of the following tests:
• Nerve function in certain parts of the leg or arm. Tapping different areas with a reflex hammer, with little or no reaction, is possibly indicative of a compressed nerve root. Sensory tests may also be conducted, utilizing hot and cold to determine how the nerve roots react to such stimuli.
• Muscle strength. In order to get a better understanding of whether the spinal nerve root is being compressed by a herniated disc, the doctor will likely conduct a neurological exam to assess muscle strength. The doctor may also ask the patient to undress in order to examine the muscles, particularly whether there is muscle atrophy, twitching or any abnormal movements.
• Pain in certain positions. The doctor may raise and extend the arms or legs, with any resulting pain a potential indicator of a pinched nerve from a herniated disc. The doctor may exert gentle pressure on the spine, with ensuing pain likely another indication of nerve root problems. Usually, this series of physical tests will give the doctor a good idea of whether or not the specific back problem or neck problem is caused by a herniated disc, degenerative disc disease, or another problem.

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3. Diagnostic tests. After forming an opinion on the cause of the patient’s pain, a diagnostic test may be ordered to confirm the disc problem and/or to gain additional information, such as the location of a herniated disc and impinged nerve roots. Diagnostic tests may include a:
• CT scan. Computerized technology (CT) scans work like an x-ray in that an x-ray beam goes through the body, with a computer reformatting the image into cross sections of the spine.
• MRI scan. Magnetic Resonance Imaging (MRI) allows doctors a sensitive and accurate assessment of the spinal nerves and anatomy, including disc alignment, height, hydration and configuration.
• Discogram. If surgery for disc pain is considered, some practitioners may recommend a discogram with the goal of confirming which disc is painful. In this test, radiographic dye is injected into the disc, and if the patient’s normal pain is recreated, then it is likely that specific disc is the cause of the patient’s pain. This test is controversial as to whether or not it is a valid, accurate test, and many doctors do not use discography except in rare situations.

MRI Is Not a Medical Diagnosis

The test findings on an MRI or other test are not in and of themselves a diagnosis of a herniated disc or degenerated disc as the cause of the patient’s pain. Many people over the age of 30 will have some level of a disc problem, but few will have pain.

Quite simply, a patient’s physical exam findings and symptoms need to match the MRI or other test findings to arrive at an accurate medical diagnosis and understanding of the cause of the patient’s pain.

• Article written By:
• Peter F. Ullrich, Jr., MD

July 31, 2009

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