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| Patient Education -- Patient Testing |
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The
MRI: Magnetic Resonance Imaging Test
The CT: Computed Tomography Test
Myelogram CT
Epidural Steroid Injection
Facet Joint Injection
The EEG: Electroencephalogram
Test
The EMG: Electromyography Test
The NCV: Nerve Condition Velocity Test
Neuropsychology Test
Nerve/Muscle Biopsy
Discography
Doppler Ultrasound
Electromyography (EMG)
The MRI: Magnetic Resonance Imaging
Test
An MRI is a method of taking pictures inside your body.
A scanner collects images from your body's natural magnetic
properties. The machine takes these pictures while you
rest on a scanning couch. The MRI scanner is basically
a large magnet with a space in the center. A powerful
computer changes this data into images. An MRI is performed
to show areas where body chemistry has been disturbed
by disease or illness. It does not hurt. You will feel
no pain or treatment. No needles or injections are used.
It takes about 45 to 90 minutes.
Prior to the test being performed, notify your doctor
if you have any metal or metal fragments in your body.
Additionally, if you have fears about being enclosed in
a small space (claustrophobia), a mild sedative may be
given to relieve you of anxiety. If a sedative is used,
bring someone to drive you home. Eat normal meals and
continue taking prescribed medications unless your doctor
gives other instructions.
You will be asked to put on a hospital gown and remove
watches, jewelry, or any other metal objects you might
be wearing. You will lie down on the scanning couch, arms
at your side, and your head cradled in the head rest.
If you have long hair, it will be tucked into the head
rest. For a head and neck image, you will be slid into
the scanner head first. You will be asked to keep as still
as possible while images are being made. You may breathe
normally throughout the test. As the scan begins, the
couch will slide into the giant magnet. You will hear
some peculiar machine-like noises during the test
If you experience any anxiety or feel sick, talk through
the two-way microphone with the technologists. Most scanner
rooms are equipped with a TV camera so that you can be
seen clearly throughout the test. Someone is always available
to make you feel comfortable.
There are no after-effects from the MRI scan. You should
feel just as you did before the scan. The images will
be reviewed immediately for quality. If more images are
needed, they will be taken right away. If not, you may
go back to your hospital room, the clinic or go home.
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The CT: Computed Tomography Test
A CT scan is a method of taking pictures inside your body.
A scanner produces a series of images, many of them that
do not show up on conventional x-rays. The scanner takes
these pictures while you rest on a scanning couch. For
some scans, a dye will be injected to outline blood vessles
or organs so that they can be seen more easily. The test
takes about 30 to 90 minutes, although scans of the head
may take longer. CT scans are completely painless. However,
some patients may experience slight discomfort from the
injection of a dye. There are no after-effects from the
CT scan. You should feel just as you did before the scan.
A CT scanner is a large, donut-shaped chamber that houses
an X-ray tube and a detector that sends information to
a computer. You will lie on a couch which will gradually
slide into the chamber as the scanner takes its pictures.
To prepare for the test, you may be asked not to eat for
at lest 3 hours before the scan
if a dye is to be used during the scan. Do not drink anything
for one hour before the test. Give a complete list of
any medications you are currently taking to your doctor.
Tell your doctor or radiologist all details concerning
the following aspects of your current health: if you are
pregnant, diabetic, allergic to any foods or drugs, if
you had any previous side effects to a contrast medium
or dye in the past, or if you have had or are presently
being treated for an infection anywhere in your body.
You must put on a hospital gown and remove watches, jewelry,
or any other metal objects you might be wearing. You will
lie down on the scanning table. You will be positioned
comfortably, generally with your arms at your sides and
your head cradled in the headrest. If you have long hair,
it will be tucked into the headrest.
The part of your body to be scanned must be positioned
in the middle of the scanner ring. You will be asked to
keep as still as possible during the scan. You may breathe
normally throughout the scan. If a contrast medium (dye)
is used, the radiologic technologist will probably take
some preliminary scans before the radiologist injects
the dye. You will hear clicking and buzzing noises as
the mechanism in the scanner moves around your body.
There is no need to worry. The radiologist and the technician
can see you through an observation window. The scanner
has a two-way intercom so that you can talk with the technologists.
Someone is always available to make you comfortable.
After the test, the images will be reviewed for quality.
If they are acceptable, you may return to your hospital
room or go home, unless given other instructions from
the doctor.
If more images are needed, they will usually be taken
right away. Unless you have other tests scheduled, you
may eat normal meals after the exam. Drink plenty of fluids.
They will help eliminate the contrast medium from your
body (if one was used). When the test results are complete,
you will be informed of them either at the time of your
visit or from your personal physician.
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Myelogram CT
Myelogram CT is performed to examine the spinal canal
and to determine if there are any cord or nerve root compressions.
During the procedure, a safe material is injected into
the spinal cord and pictures are taken. Then, a CT scan
is performed to further evaluate your spine. There is
a slight chance that the patient will experience a headache
after this exam.
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Epidural Steroid Injection
The epidural space is a small space surrounding the nerves
inside your spinal canal. Your physician will order this
procedure to relieve pain and soreness in either your
cervical spine or lumbosacral spine. A cervical epidural
steroid injection is useful to alleviate neck pain with
or without arm pain. A lumbar epidural steroid injection
is useful to alleviate low back and leg pain by reducing
inflammation. The injection may provide pain relief for
weeks or months. In some cases, the patient may need more
than one injection to get pain relief.
During the procedure, you will be placed on your abdomen
or side. Stay as still as possible. X-ray is used to identify
the area that will receive the treatment. You may be given
medication through an IV line to help you relax. The skin
over the injection site is cleaned and a local anesthetic
numbs the skin. A needle will be inserted in the epidural
space. A special material is injected to make sure the
needle is placed correctly and to make sure this medication
is distributed to the side with the pain. Then a long-acting
anti-inflammatory steroid is injected. Occasionally during
a lumbar injection, the thecal sac may be penetrated.
Once the procedure is completed, the patient may resume
normal activity.
Risks and complications are rare, but may include infection,
spinal headaches, bleeding or fluid leakage in the spinal
cord, nerve damage, and prolonged increase in pain.
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Facet Joint Injection
Back or neck pain may be caused by a problem with your
facet joints. Bones called vertebrae make up your spine.
Each vertebrae has facets (flat surfaces) that touch where
the vertebrae fit together. These form a structure called
a facet joint on each side of the vertebrae. One or more
faceyt joints in your back or neck can become inflamed,
swollen, and irritated which may cause pain.
To help you relax, medication may be given through an
IV line. You will lie on an exam table on your stomach,
back, or side. This depends on where you will be injected.
During the treatment, the skin over the injection site
is cleaned and a local anesthetic numbs the skin. X-ray
imaging may be used to help the doctor see your spine
and a contrast dye maybe injected into the affected area.
Then, medication is injected into the inflamed joints
in order to reduce inflammation and relieve pain. Once
the treatment is completed, the patient can go home in
about an hour. The anesthetic wears off in a few hours.
When it does, your back or neck may feel more sore than
usual. This is normal. The steroids usually begin to work
in 3 to 4 days. Pain relief should last for weeks or months.
If the pain returns, a repeat injection is needed.
Risks and complications are rare, but may include injection,
bleeding, prolonged increase in pain, and nerve damage
(very rare).
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The EEG: Electroencephalogram
Test
An EEG is a recording of the electrical activity in your
brain. Electrodes are attached to your head so that this
electrical activity can be measured and recorded. The
test is used to help evaluate the health of the brain
and to diagnose nervous system disorders. It is a tool
that evaluates the electrical patterns of your brain to
determine if there is abnormal electrical activity. Your
EEG may be performed while you are awake or while you
are asleep and normally takes about 1 1/2 hours. Most
EEGs are performed if you are experiencing blackouts or
spells of various nature, seizures, headaches, depression,
a sleep disorder, dizziness, problems with memory, or
weakness of arms and legs. It does not hurt. You will
not experience any pain or discomfort. The EEG is NOT
a shock treatment. It is not an intelligence test. It
cannot tell what you are thinking. Nothing is put into
or taken out of your brain.
Because the brain's electrical activity differs depending
on whether you are asleep or awake, an EEG recorded while
you are sleeping can be very informative, especially when
seizures or any type of spell is suspected.
To prepare for the test, wash your hair and avoid using
any sprays, oils, or dressings of any kind. Eat normal
meals. Continue to take prescription medications unless
your doctor gives other instructions. If you have a "sleep"
EEG, you may be asked to sleep less the night before the
test, and to bring someone with you to the lab to drive
you home.
You will recline in a comfortable chair and asked to remain
very still. A soft, red pencil will mark areas where electrodes
will be glued on your scalp. Some special jelly is applied
to each electrode, and each electrode is checked with
a meter to ensure proper functioning. Lie very still and
close your eyes. At certain times, you may be asked to
open and close your eyes, and to breathe deeply for about
three minutes. For one part of the test, a strobe light
will temporarily flash on and off. You may be given a
sedative to help you relax and sleep. After the test,
the electrodes are removed with acetone, which dissolves
the glue and leaves your hair and skin intact. You may
return to your hospital room or home, unless given other
instructions from your doctor. You may wash your hair.
If you have been given a mild sedative, you should be
driven home by a relative or friend. You will learn the
test results either from the doctor before you leave,
or from your personal physician.
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The EMG: Electromyography Test
An EMG evaluates the health of your muscles by measuring
electrical activity. A thin, small electrode (needle)
is inserted into one of your muscles, which is evaluated
at rest and at various degrees of contraction. The test
takes about 30 minutes to one hour
An EMG is performed if you are experiencing weakness in
your arms, legs, hands, or face. It can determine whether
weakness is due to muscle disease, nerve disease or disease
of the junction between nerve and muscle. You may experience
some pain when the needle is inserted into each of the
muscles being tested. Some discomforts should be expected
during this test. The EMG is not acupuncture or a skin
treatment of any kind. Nothing is injected into or under
your skin.
To prepare for the test, eat normal meals. Continue to
take prescription medications unless your doctor gives
other instructions. Tell your doctor if you are taking
a "blood thinner" such as coumadin, heparin, or aspirin,
or if you bruise easily.
Before the EMG begins, a doctor will give you a brief
neurological exam to check your nervous system and muscles.
You will then lie on an examination table. The doctor
will insert a needle electrode into the muscle. Your muscle
will then be evaluated at rest. During this phase, the
needle is moved several times so that various sections
of the muscle can be tested. This may cause some discomfort.
You will be asked to flex your muscles slightly, and then
as hard as you can, and additional measurements will be
taken. The number of muscles to be tested depends in the
problem you have and what is found during the test. After
the test, you may return to your hospital room or go home,
unless given other instructions from the doctor. There
might be a slight tenderness in the muscles that were
tested, but this should go away in a few hours. Your muscles
may also ache for 1 or 3 days. You will learn the test
results either from the doctor before you leave, or from
your personal physician.
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The NCV: Nerve Condition Velocity
Test
An NCV test evaluates the health of the peripheral nerve.
Stimulating electrodes are placed at different points
on a limb and an electrical pulse is generated. Recording
electrodes placed on a muscle elicits a waveform produced
by the nerve when the pulse
is generated. The information received can help to identify
a problem area. It measures the speed of an impulse traveling
along a motor nerve (one that goes to a muscle) or a sensory
nerve (one that detects sensations). It takes about 30
to 60 minutes and is performed if you are experiencing
muscle weakness, numbness, nerve injury, mechanical nerve
pressure, or nerve disorders due to a variety of diseases.
During the test, your muscles may twitch or tingle and
there may be some discomfort. The NCV is NOT a shock treatment
or a therapy of any kind.
To prepare for the test, eat normal meals and continue
to take prescription medications, unless your doctor gives
you other instructions.
You will lie on an examination table while "stimulating"
and "recording" electrodes are placed on different areas
of your limbs. A "pulse" from the stimulating electrodes
will be measured by the recording electrode, which elicits
a waveform. Following the test, the electrodes will be
removed. You may return to your hospital room or go home,
unless given other instructions by your doctor. You will
learn the test results from the doctor either on the day
of the visit, or from your personal physician.
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Neuropsychology Test
The Neuropsychology test is a series of tests that evaluate
your intellectual functioning, memory, speech and language,
perception, planning, judgement, decision-making, and
personality. The results of these tests help your doctor
make an accurate diagnosis of neurological disease. In
addition, they aid in the selection of appropriate rehabilitation
procedures. The test usually takes about 2 hours. You
should experience no pain or discomfort.
To prepare for the test, eat normal meals and continue
to take prescription medications unless your doctor gives
you other instructions. Be sure to get a full night's
sleep.
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Nerve/Muscle Biopsy
A biopsy is a minor surgical procedure where an incision
is made to remove a small sample of muscle or nerve. Muscle
and nerve biopsies are done for 2 purposes:
1.To diagnose certain abnormalities in the muscle and/or
the nervous system.
2.To check the progress of an already diagnosed condition.
Before being scheduled for a biopsy, the physician will
perform a brief medical history and a physical examination
which may include blood work and testing of the muscle
and nerves. Please tell your doctor at this time if you
have any allergies. Also, tell the doctor at this time
if you are on any aspirin, aspirin products, coumadin
or heparin. These medications cause abnormal bleeding
at times. As an outpatient, you will be asked to fast
from midnight on and until the procedure is done. Notify
your doctor if you are a diabetic. Report to the clinic
the day of your procedure at the scheduled time. The nurses
will finish the necessary preparations and you will be
taken to the operating room. After the procedure, the
operating room personnel will take you to recovery where
you will receive further instructions.
Medications used during the procedure may make you drowsy,
so you must have someone present to drive you home. Wear
clothing that is comfortable and easy to put on.
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Muscle
The muscle biopsy is relatively simple and takes approximately
one hour to perform. The doctor makes a small (2 inch)
incision over a muscle that has been selected on the basis
of your symptoms. The most commonly used muscles are the
biceps in the upper arm; the deltoid in the shoulder;
or the quadricep in the upper thigh. The cosmetic effect
may also be considered when the site is selected.
After the incision has been made and the muscle identified,
the doctor takes the muscle sample. You may feel a brief
and mild discomfort as this is done. The sutures (stitches)
which the doctor uses to close the incision will dissolve
so they do not need to be removed. Small paper tapes will
be placed over the incision to keep the skin together.
These tapes can be removed after 7-10 days. A sterile
dressing is applied over the paper tapes. This dressing
stays on for 7-10 days also.
Nerve
The nerve biopsy takes about 1 hour. The incision is made
above the outer ankle bone (which is the sural nerve)
and is about 5 inches. The rest of the procedure is similar
to the muscle biopsy. When the nerve is clipped, you may
feel an electrical sensation. A pressure dressing, by
use of an ace wrap, will be placed on the site. The pressure
dressing will be on for the first 24 hours to avoid bleeding
and swelling.
Remember to keep your incision dry for the first 7 to
10 days. To take a shower or bath you must do one of the
following to keep the site dry:
1.Take a sponge bath at the sink;
2.hold your arm out of the water if the site is your arm;
3.cover the area with plastic sheeting (plastic wrap or
garbage bags), and tape it with plastic tape that is available
at your drug store.
After the 7-10 days, the dressing may be removed and the
biopsy site should be healed enough to resume bathing
in your usual manner. Avoid excessive use of the biopsied
muscle or nerve for the first 12 days. If your leg is
involved, stay off your feet as much as possible for the
first 24 hours. If you must be up and about, you should
consider using crutches. Keep your leg elevated whenever
possible the first 24 hours. If your arm is involved,
limit its use the first 24 hours. Because you need to
limit your activity, you may want to ask the doctor about
a work release. Limiting your activity will minimize the
pain and any chance of bleeding.
Ask your doctor what you should take for pain. In most
cases, acetaminophen (Tylenol) will take care of any pain.
If you remain in the hospital, the doctor may change the
dressing and check the biopsy site.
Although this procedure has few complications, please
call your doctor or the if you have pain after the first
72 hours, redness or swelling around the incision, or
drainage other than a small amount of fluid during the
first 24 hours.
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Discography
This test is used to determine if intervertebral discs
in the spinal column are a source of pain. This test involves
the placement of a needle into the disc spaces while utilizing
x-ray guidance and injecting contrast material (dye).
The discs are soft, cushion-like pads, which separate
the hard vertebral bones of the spine. A disc may cause
pain in the neck, mid-back, low back, arms, chest wall,
abdomen or legs when it bulges, herniates, tears or degenerates.
CT and MRI scans only illustrate anatomy and cannot prove
a patient''s source of pain. In some cases, discs may
appear abnormal on MRI or CT scans but not be the source
of pain. A discogram can help identify discs that cause
pain and help the neurosurgeon plan the correct surgery.
A negative discogram can help avoid surgery that may not
be beneficial. Because of the nature of the test, discography
is usually done only if the patient''s pain is significant
enough to consider surgery.
During the procedure, an IV is started to administer antibiotics
and relaxation medication. The patient will lie on his/her
back for discography of the cervical spine and on his/her
side for discography of the thoracic and lumbar spine.
The physician numbs the skin, then directs a small needle,
using x-ray guidance, into the space of the suspect disc.
The procedure may be performed at more than one disc level
at the same time. After the needle is properly positioned,
a small amount of contrast is injected into each disc.
Immediately thereafter, the patient is taken to the CAT
scan machine where additional images are taken. Following
the CAT scan, patients are taken to a recovery area and
monitored for 30 to 60 minutes. A prescription for pain
medication often helps with managing muscle discomfort
that may occur for a few days after the procedure.
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Doppler Ultrasound
This is a basic imaging test to judge the health of the
carotid arteries and is done as part of an assessment
of a patient''s risk of stroke. It is a non-invasive test
that takes about 15 to 20 minutes. The patient reclines
on an exam table and the physician passes an electronic
hand-held device over the body area of concern, pressing
the device directly across the skin. The device transmits
sound waves that are reflected from the structures in
the neck and reconstructed into a picture of the outsides
and inside of the artery walls. The Doppler can also use
changes in the reflected sound waves to determine the
velocity of blood flow through the artery. Just like stepping
on a garden hose, a high velocity implies a narrower vessel.
The Doppler ultrasound usually can only visualize arteries
in the neck.
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Electromyography (EMG)
This test is used to learn more about the functioning
of peripheral nerves (those in the arms and legs). It
can tell if a nerve is pinched, and give an estimate of
how severely, and where it is compromised. An EMG tests
for the electrical impulse coming from the brain and/or
spinal cord to the affected area. If that impulse is blocked
somewhere along the spinal pathway, it may be delayed
or reduced enroute to its final destination (skin, muscle,
finger tips, etc.) Therefore, abnormal function could
mean there is nerve injury or muscle dysfunction.
Muscles receive constant electrical signals from properly
functioning nerves, and in turn they broadcast their own
electrical signals. During an EMG, the electrical activity
in muscles is measured. The doctor places very thin needles
(like those used in acupuncture) into the muscles to record
the electrical signal from the various leg or arm muscles.
If a muscle doesn''t receive adequate impulses from its
nerve, it broadcasts signals that indicate the muscle
is confused.
The results of this test are usually correlated with the
results from the Nerve Conduction Study, allowing the
doctor to determine which nerves are pinched and the degree
of malfunction.
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