Usually the first appointment for a worker with a herniated disc is with an urgent care office or a primary care physician for low back or leg pain. If rest and therapy do not resolve the symptoms or if the radiculopathy is pronounced, the worker may be referred to spine expert such as an orthopedic surgeon or a neurosurgeon. Diagnosis begins with a complete history and physical exam. The doctor will ask questions about the symptoms and how the problem is affecting one’s daily activities. These will include questions about where one feels pain and whether there is numbness or weakness in the legs. The doctor will also want to know what positions or activities make the symptoms worse or better. For example, it is very important to let the doctor know if one’s work or job duties aggravate or cause your symptoms. Doctors rely on your report of pain to get an idea which disc is causing problems and if a nerve is being squeezed. Then the doctor examines you to determine which back movements cause pain or other symptoms. Your skin sensation, muscle strength, and reflexes are also tested.
X-rays are of minor help in diagnosing disc herniations. The discs don’t actually show up on X-rays. However, doctors can tell if the space between the vertebrae is smaller than normal. This can be an indication that wear and tear on one or more discs is causing problems.
Computed tomography (a CT scan) may be ordered. This 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 the subarachnoid space. When the CT scan is performed, the dye highlights the spinal cord and nerves.
When more information is needed, your doctor may order magnetic resonance imaging (MRI). The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body. It gives a clear picture of the discs and whether a herniation is present. Like the CT scan, this machine creates pictures that look like slices of the area your doctor is interested in.
A specialized X-ray test called discography with dye may be used when surgery is being considered to determine which disc is causing problems.
An EMG is an electrical test to locate more precisely which spinal nerve is being squeezed by measuring how long it takes a muscle to work once a nerve signals it to move.
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