Common Tests and Procedures


What is a CT Scan?

A computed tomography scan is a test that takes a series of X-rays of your bones and a computer constructs these images into cross-sectional views displayed on a monitor. The CT scan shows in detail a specific plane of involved bone and can reveal tumors of the soft tissue, or injuries to the ligaments, and tendons. The CT scan can be used to identify the location and extent of fractures in areas difficult to evaluate. A contrast dye may also be used, which helps improve the resolution and accuracy of the images. Before the test you do not need to fast unless contrast dye is ordered. The test takes approximately one hour to complete and the patient must remain still the entire time. During the test the patient lays on a special table and the head of the table is moved into the scanner. If contrast dye is used the patient may have a warm flushed feeling, and may experience a headache or nausea. All of these reactions are normal and last for a short period of time. After the test the patient may resume normal activity. If contrast dye was used the patient will be monitored for a delayed allergic reaction and will be encouraged to drink plenty of fluids to help eliminate the dye from the body.

What is an MRI?

Magnetic Resonance Imaging (MRI) is a painless, noninvasive procedure that uses magnetic waves, radio waves, and computers to detect abnormalities. The unique feature about the MRI is that it does not require exposure to radiation. The test takes approximately 90 minutes to complete, and involves being placed on a narrow platform that slides into a tube containing a doughnut shaped magnet. The opening for your head and body is small and deep, therefore if you have experienced claustrophobia in the past you may need a sedative to help relax. However, there is a new open MRI machine that is not as confining and may be requested if you have experienced claustrophobia. During the test, you may hear the scanner clicking or thumping as it moves. This is completely normal. You will be asked to lay completely still throughout the test because any movement can cause artifact on the scan. However, you will be able to talk with the technician at all times during the test. Before you undergo the MRI the nurse should assess for any metal implants, clips, pacemakers, or metal fragments in your body. (Because the MRI works through the use of powerful magnets it can not be performed on people with metal in their body. The magnet could move the object within the body causing injury.) After the test, you may return to normal activity with no special post procedural care needed.

What is a Joint Injection?

Sodium Hyaluronate is a medication used for patients diagnosed with osteoarthritis of the knees. The brands of this medication used in our office are: Hyalgan, Synvisc and Euflexxa. It is used for patients who do not get relief from simple pain killers, exercise, or physical therapy. Hyalgan is a sterile mixture that is derived from rooster combs. It contains hyaluronan, a natural chemical found in the body with particularly high amounts found in the joints. Hyalgan is given in the doctors office and is injected directly into the knee. The treatment consists of a series of three to five injections given at weekly intervals. The length of pain relief may differ on an individual basis. In some cases the pain relief has lasted up to 26 weeks. Before the injection is given the doctor injects a local anesthetic to help decrease the discomfort of the Hyalgan. During the injection of the medication the patient may feel minimal pain at the injection site. After the injection the patient may experience mild pain or swelling, with occasional redness, itching, or bruising around the joint. These side effects are mild and generally do not last long. Hyalgan should not be used if the patient has had previous allergic reactions to it, or any medications containing Hyaluronan. Hyalgan should also not be given if the patient has had an infection or skin disease in the area of the injection site. Immediately after the injection and for the next 48 hours the patient may need to avoid increased physical activity, such as jogging, heavy lifting, or standing for long periods of time.

What is an Arthrogram?

An Arthrogram is a test using X-ray and a contrast material (such as a dye, water, air, or a combination of these) to take pictures of a joint.

What is a Doppler?

A Doppler ultrasound test uses reflected sound waves to evaluate blood as it flows through a blood vessel. It helps doctors evaluate blood flow through the major arteries and veins of the arms, legs, and neck.

What is a Bone Scan?

The Bone Scan is a test used to examine the skeleton. It helps the doctor to detect cancer, difficult-to-find bone fractures, bone infection, degenerative bone disorders, or evaluate unexplained bone pain. This test can detect problems long before an X-ray could. The test is performed by injecting a slightly radioactive solution into a vein in the patient’s arm. The scan is then performed approximately two to three hours after the solution is injected. A special camera is passed over the entire body and can pick up any abnormalities. The radioactive solution accumulates at the abnormality. These abnormalities are known as “hot spots”. The test is relatively painless and will take approximately one hour to complete. Before the test the patient will be asked to drink four to six 8-ounce glasses of water to help distribute, as well as eliminate the radioactive solution. After the test there may be slight redness or swelling at the injection site, however, normal activity may be resumed.

What is a Bone Density Study?

The bone density test is used to determine bone mineral content and bone density. This test helps to diagnose osteoporosis as early as possible. The earlier osteoporosis is detected, the more effective the treatment and the milder the clinical course. If osteoporosis is not detected until fractures occur, or thin bones are seen on plain film X-rays, the success of treatment is less likely. The dual energy X-ray absorptiometry, or DEXA scan is the most common bone density exam used. Before the test is performed there is no fasting or sedation required. The patient will be asked to remove all metallic objects that may be in the scanning path. During the procedure the patient lies on an imaging table. There is a photon generator under the table that is continuously passed under the body. A camera is passed over the patient parallel to the generator. The image is then projected onto a computer screen. The bone density test takes approximately 30-45 minutes and is pain free. This test also uses only minimal radiation. After the test the patient may resume regular activity.

What is an ESI?

An ESI, or epidural steroid injection, is an injection of both a long lasting steroid and an anesthetic numbing medicine in the epidural space. The epidural space is the area that surrounds the spinal cord and nerves coming out of it. The ESI can help to relieve neck, arm, low back, and leg pain caused by irritated nerves. The steroid that is injected helps reduce swelling of the nerves, and in turn may reduce pain, tingling, and numbness. An ESI is usually performed on patients with stenosis: a narrowing of the spinal and nerve root canal causing neck, back, or leg pain, spondylolysis: a weakness or fracture between upper and lower vertebrae, and a herniated disc: which occurs when the gel like center of a disc in the spine pushes out from the center. The procedure is performed under local anesthesia and is done with the patient sitting up, on the side, or on the stomach. The procedure involves inserting a needle through skin and deeper tissues, so there is some discomfort involved. The entire procedure itself lasts approximately ten to fifteen minutes. After the treatment the patient may experience slight numbness. The patient’s blood pressure and heart rate will be monitored for a short period before being discharged to home. The patient should bring someone to drive them home and will be asked to take it easy for 24-36 hours after the injection. The steroid should start working in about three to five days and relief can be expected to last for several weeks to several months. The patient may have a series of three injections in a six month period. These injections are usually given two weeks to a month apart. Pain relief varies in each individual. This procedure should not be performed if the patient is allergic to any of the medication to be injected, if taking a blood thinning medication, or if the patient has an infection going on.

What is an EMG/NCV?

An EMG, or electromyography is a test used to measure the electrical activity of certain skeletal muscle groups at rest and during voluntary contraction. The EMG is performed to help diagnose neuromuscular disorders, to evaluate diseases caused by the degeneration of nerve tissue, or to distinguish between primary or secondary muscle disorders. This test lasts approximately one hour and minimal discomfort may be felt. The patient may be asked to restrict caffeine for two to three hours before the test takes place. During the test the doctor inserts a needle electrode into selected muscles and measures the electrical discharge of the muscle. The muscles electrical signal is recorded during rest and contraction. After the test there may be mild discomfort at the injection sites and warm compresses may be applied to help with the irritation. If there is no discomfort regular activity may be resumed as tolerated.

An NCV, or nerve conduction velocity test is usually performed in conjunction with the EMG. The NCV allows for the detection and location of peripheral nerve injury or disease. A mild electrical shock is given to the patient to stimulate a particular nerve. A recording electrode that is placed a set distance from the site of the shock detects the response from the stimulated nerve. The lag time between the shock and the response is measured. When a peripheral nerve injury or disease is present the lag time will be abnormal. After the test the patient may return to regular activity as tolerated.

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome is a term used to describe nerve damage in the wrist. This nerve damage can cause pain, tingling, numbness, and weakness in the hand, especially in the thumb, index, and middle fingers. Most people with carpal tunnel syndrome experience these symptoms at night.

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