Diagnosis of a herniated disc is made after an injured worker presents with neck or low back and arm or leg pain symptoms. Insurance companies routinely deny that a herniated disc is work-related. Diagnosis is an important step in proving that a herniated disc is work-related.
Diagnosis begins with a complete history. It is important the doctor be given an accurate, consistent history of the work accident or job duties that caused the pain; the location of the pain, and what daily activities worsen the pain.
Next the doctor performs a physical exam to determine which back movements cause pain or other symptoms such as numbness or tingling. Skin sensation, muscle strength, and reflexes are also tested.
X-rays are of minor help in diagnosing disc herniations, as soft tissue discs don’t visualize on X-rays. However, smaller space between the vertebrae can indicate a disc injury. X-rays may also show vertebra degeneration or damage often consistent with a disc injury.
Computed tomography (a CT scan) is a detailed X-ray that lets doctors see slices of the body’s tissue. The image can show if a herniated disc is putting pressure on a spinal nerve.
Doctors may combine the CT scan with myelography. To do this, a special dye is injected into the space around the spinal canal, called the subarachnoid space. When the CT scan is performed, the dye highlights the spinal cord and nerves. The dye can improve the accuracy of a standard CT scan for diagnosing a herniated disc.
The best results for diagnosing a herniated disc is from magnetic resonance imaging (MRI). An MRI uses magnetic waves to show the soft tissues giving a clear picture of the discs and whether a herniation is present. Like the CT scan, MRIs create pictures that look like slices of a body part. The test does not require special dye or a needle.
A discography involves inserting needles into the discs, then fluid is injected to pressurize the disc and any pain responses are recorded. A CT scan afterward can detect disc leakage due to tears or fissures in the disc anulus fibrosus, which surrounds the jelly-like nucleus pulposus.
An electromyography (EMG) test is an electrical test to locate more precisely which spinal nerve is being affected. The time it takes to signal a muscle to move will be slower if a herniated disc has put pressure on a spinal nerve. A somatosensory evoked potential (SSEP) test measures how well nerves are transmitting sensations such as pain, temperature, and touch.
At McCormick Law Office, the attorney reviews the medical records to confirm the best results are obtained when the reported herniated disc symptoms are consistent with objective diagnostic testing results.