Thursday, 12 June 2014

How Herniated Disk Is Diagnosed With Precision

What is Herniated Disk?
A herniated disk or ruptured or slipped disk is an issue with one of the disks or cushions between the vertebrae or individual bones that make up the spine. A spinal disk has a soft center with a tougher exterior. When some of the soft inner portion pushes out through a crack in the exterior, a herniated disk occurs.
Many people do not have any symptoms with a herniated disk. Sometimes the disk can irritate nearby nerves, causing arm or leg pain, weakness or numbness.
A physician must find the source of the pain to diagnose a herniated disk. As such, he must use a combination of findings from the medical history, physical exam and diagnostic testing to make a proper diagnosis.
  • Medical history.
    The physician will take a full medical history. Be prepared to discuss when the low back pain and other symptoms occur, how the pain feels (i.e. stabbing) and if there are specific activities, positions or treatments that make the pain better or worse.
  • Physical exam. The physician will conduct a comprehensive physical exam that includes testing nerve function and muscle strength in particular areas of the arm or leg and testing for pain in certain positions. He'll check your reflexes, muscle strength, walking ability and capacity to feel light touches, vibration and pinpricks.
  • Diagnostic tests. Typically once a doctor has a good idea of the pain source, he uses CT and MRI scans to confirm that there is an anatomical lesion in the spine. This testing provides a detailed picture of the herniated disk and impinged nerve root locations. In some cases, a physician may also order a myelogram, in which dye is injected into the spinal fluid and X-rays are taken. A myelogram can reveal spinal cord or nerve pressure due to multiple herniated disks or other conditions.
As previously mentioned, it is not uncommon to have a herniated disk without even knowing about it. However, it can be quite painful. Typically herniated disks occur in the lower back or lumbar spine although they can occur in the neck or cervical spine.
The most common signs and symptoms include the following:
  • Arm or leg pain. Many people experience the most intense pain for lower back herniated disks in their calves, thighs and buttocks. Sometimes the pain also spreads to the foot. For neck herniated disks, the most intense pain is often in the arm and shoulder. The pain can travel to the leg or arm when you sneeze, cough or move your spine into certain positions.
  • Numbness or tingling. The herniated disk affects nerves that serve a particular part of the body which may be numb or tingly.
  • Weakness. The affected nerves also agitate muscles which tend to weaken in the event of a herniated disk. The weakness may cause you to stumble or have a compromised ability to hold or lift items.
    If your back or neck pain moves into the arm or leg or you experience any type of numbness, tingling or weakness alongside the pain, you should seek medical help.
Nine out of ten people who have a herniated disk experience relief in symptoms from conservative treatment that includes planned exercise and a pain medication routine. In rare instances, if these treatments do not improve symptoms, surgery is required.
Over-the-counter pain medications. Over-the-counter options such as ibuprofen and naproxen may suffice for mild to moderate pain.
  • Narcotics. Narcotics are the next option after over-the-counter medications. They can only be used for short periods of time.
  • Nerve pain medications. Pregabalin, gabapentin, amitriptyline, duloxetine and tramadol can relieve nerve damage pain. As they have fewer side effects than narcotics, some physicians opt to prescribe them first.
  • Muscle relaxers. A physician may prescribe muscle relaxants if you have muscle spasms.
  • Cortisone injections. Corticosteroids that suppress inflammation can be injected right into the region surrounding the spinal nerves.
There are a number of exercises and positions that can reduce herniated disk pain. A physical therapist may also suggest heat or ice, ultrasounds, traction, electrical stimulation and/or short-term lower back or neck bracing.
If conservative treatment does not improve symptoms within six weeks, a doctor may recommend surgery, particularly if you continue to have trouble standing or walking, significant weakness or numbness or loss of bladder or bowel control.
For most herniated disks the surgeon can simply take out the portion of the disk that has slipped out of place. In rare instances the entire disk must be removed.