DIAGNOSTIC TESTING

Types of Tests

Innovative Health Centers uses the latest equipment and techniques in electro-diagnostics. We adhere to the parameters set forth by the U.S. Department of Health and Human Services and N.I.O.S.H. Our on-staff physicians are Board Certified in their respective fields of expertise. Our technicians are highly trained and adhere to the objectives set forth by the American Association of Electro-diagnostic Technologists (AAET) and the American Society of Electro-diagnostic Technologists (ASET).

There are two types of tests you can order:

1. NERVE STUDY:
   
   
   • Nerve Conduction Velocity (NCV), F-wave/H reflex
     
   • Dermatomal Somatosensory Evoked Potential (DSEP)
     
   • Needle Electromygraphy (EMG). (In some states)
     
   • Upper exam includes the nerves from the Brachial Plexus
     
   • Lower exam includes sthe nerves from Lunbo-Sacral Plexus
     
   • Upper and Lower exam can be ordered if warranted
     

We are looking to diagnose radiculpathies, neuropathies, demylination of the nerve, and axonal loss. We evaluate both the motor and sensory components of the nerves.

2 . DIAGNOSTIC SPINAL ULTRASOUND

• The focus will be on the facet, muscle and ligament of the vertebral and paravertebral region for any inflammation due to the patients injury
  
• Upper exam consists of the Cervical Spine, T1-T6 and Trapezius muscles bilaterally.
  
• Lower exam consists fo T6-T12, Lumbar spine, amd Sacroiliac joints bilaterally.
  
• Upper and Lower exam can be ordered if warranted
  

Doctors frequently order a nerve study and a spinal ultrasound for the effected area.

NERVE STUDY

The nerve study consists of a Nerve Conduction Velocity (NCV), F-wave/H-reflex and Dermatomal Somatosensory Evoked Potential (DSEP) tests. The upper exam is diagnosing the function of the nerves from the brachial plexus fand their branches into both arms. The lower exam is diagnosing the nerve function through the lumbo-sacral plexus into both legs. We diagnose the integrity of the nerve by the following criteria:

• Reaction time (latencies)
  
• Velocities of the effected nerve
  
• Amplitude of the captured waves
  

We test both motor and sensory components of the nerve allowing us to get a complete picture of the patients problem areas.

The clinical utility of EVOKED PPOTENTIALS (EP'S) and NERVE CONDUCTION VELOCITIES (NCV'S) is based on their ability to:

1. demonstrate abnormal sensory funtion when the history and/or neurological examination are equivical
   
2. reveal the presence of clinically unsuspected malfunction in a sensory system when demyelinating disease is suspected because of symptoms and or signs in another area of the Central Nervous System (CNS)
   
3. help define the Anatomic distribution of a disease process; and
   
4. monitor objective changes in a patients status.
   

These tests provide reproducible, sensitive, quantitive extensions of the clinical neurological examination. Although some of the information they provide is similar to that obtained at the bedside by an experienced clinician, EP's & NCV's are essential to the modern practice of medicine because they:

1. provide data unobtainable without the use of amplifiers and oscilloscopes
   
2. quantify and objectify data which the clinician may sense
   
3. can localize lesions within a long sensory pathway, whereas clinicians often cannot and
   
4. are more "efficient" and "cost effective" because the testing is done by paramedical personnel who can be trained more expeditiously than Neurologists, Opthamologists, and Otolaryngologists."
   

NERVE CONDUCTION VELOCITY
The Nerve Conduction Velocity (NCV) is used to measure action potentials resulting from peripheral nerve stimultion. This test is measuring Nerve Action Potentials between two sites using moderate stimulation. The latencies (times) and velocities obtained in this study will detect any neurological problems or compression of the nerves throughout the extremity.

NCV LOOKS AT NERVE FUNTIONON THE EXTEMITIES

F-WAVE AND H-REFLEX

The F-wave is looking at the most proximal segment of the nerve, including the root. The reaction time (latency) woll show if there is a delay at the spinal level of the particular nerve.

The Tibial H-reflex is considered to reflect the state of the S1 nerve root and its sensory component.

F-WAVE AND H-REFLEX LOOK AT COMPRESSION AT THE CORD LEVEL

DERMATOMAL EVOKED POTENTIAL

The Dermatomal Somatosensory Evoked Potetial (DSEP) involves mild stimulation of the dermatomal region and records the reaction time to the cortex.

DEP looks for nerve root compression
"For most neurological problems, two issues addressed by somatosensory evoked potentials (SEPs) are the verification of a conduction abnormality and the localization of that abnormality along neuraxis. Conventional SEPs to mixed nerves simulation may adequately verify a condution abnormality but not its location...From a technical standpoint, Dermatomal SEP's are easier to record than SEPs recorded along the spine and could serve as a useful technique for localization of neurological abnormalities along the neuraxis."

ELECTROMYOGRAPHY
In some states, we off the Needle Electromyography (EMG) in conjunction with our Nerve Study. Electromyography tests the integrity of the entire motor system, which consists of upper and lower motor neurons, the neuromuscular junction and muscle. It is an invasive test that requires needle insertion and adjustment at multiple sites. Activation of the motor unit will cause a potential (wave form) from the the recording needle, as well as an audible sound, which is also diagnostic. Depending on our findings, at least five muscles will be tested that correlate with the specific nerve distribution of the effected area. Our neurologist may suggest ordering a Needle EMG after the NCV test was performed.

EMG studies the intrinsic electrical properties of skeletal muscles.

PROTOCOLS/INDICATIONS/CONTRA-INDICATIONS

ORDER ELECTRO-DIAGNOSTIC TESTING WHEN:

• Subjective complaints are evident, but objective findings are not supportive.
  
• X-rays, CT or MRI are negative, yet symptoms persist.
  
• There is non-resolving radicular pain.
  
• A determination of nerve irritation or damage needs to be made.
  
• The need for further care is to be evaluated and substantiated
  
• Real versus imagined pain is questioned.
  

UPPER NCV/DEP/EMG - CLINICAL INDICATIONS

• Carpal Tunnel Syndrome
• Cord Trauma
  
• Disc Disease
  
• Hyperflexion/Extension Injury
  
• Malingering
  
• Nerve Entrapment/neuropathy
  
• Thoracic Outlet Syndrome
  
• Vertebral Subluxation Complex
  
• Sensory Dysfunction
  
• Spinal Stenosis
  
• Plexis Stretch Injury
  
• Radiculitis
  
• Neuritis/Sensory Deficits

LOWER NCV/DEP/EMG - CLINICAL INDICATIONS

• Disc Disease Syndrome
• Sciatica/Radicular Pain
  
• Tarsal Tunnel Syndrome
  
• Peripheral Nerve Trauma
  
• Vertebral Subluxation Complex
  
• Systematic Neuropathies
  
• Malingering
  
• Causalgia
  
• Nerve Root Irritation
  
• Spinal Stenonsis
  
• Plexis Stretch Injury
  
• Radiculitis
  
• Neuritis/Sensory Deficits

SPINAL ULTRASONOGRAPHY

SPINAL ULTRASONOGRAPHY ENABLES YOU TO:

• Give objective hard copy documentation of soft tissue injuries and subjective complaints
  
• Pinpoint the location of trauma
  
• Scan the spine for nerve area and muscle irregularities
  
• Baseline documentation for initial patient visit
  
• Monitor patient response to treatment
  
• Diagnostically manage sports injuries
  
• Use non-invasive testing procedures
  
• Lower ancillary diagnostic cost
  

The examination is done easily and quickly at the time of injury and is 100% reproducible. Diagnostic ultrasound uses no radiation, and can be performed with a minimum of patient preparation and no discomfort. Sonography plays a valuable role as a differential
diagnostic modality isolating the sports injury musculoskeletal trauma from the cystic or sol id nature character of a swell i ng or mass and aids in the subsequent treatment evaluation process. While the MR image has revolutionized the imaging of anatomic abnormalities, the Spinal Sonogram allows the physician to objectively identify soft tissue pathology. This practical method of monitoring the treatment and recovery of patients with soft tissue abnormalities is a well accepted adjunct to MR.

SPINAL ULTRASONOGRAPHY
The focus will be on the facet, muscle and ligament of the vertebral and paravertebral region for any inflammation due to the patient's injury.

Diagnostic ultrasound records changes to the soft tissue around each vertebra.

"Ultrasound has been available since 7972; however, it was not suggested as a
diagnostic tool in medicine until the 7940s. Further development has led to the
ability to discern fine anatomical detail. Ultrasound is now employed in obstetricsl
cardiologYt nephrologYt and gastroenterology. ...Ultrasound is a valuable and
cost-effective diagnostic modality. In pain management, its primary function is to
diagnose lesions of soft musculoskeletal structures causing pain, otherwise not
easily identified by conventional radiologic examinations."

WHEN DOES A PHYSICIAN ORDER SPINAL SONOGRAM TESTING?

1. When your patient begins treatment, or 7 -10 days post trauma; to establish a treatment plan and baseline pathology.
   
2. When your patient does not respond to care as anticipated.
   
3. When your patient has subjective complaints, but the objective findings do not support their complaints.
   
4. When there are negative X-Rays, CT scans or MRI'S; yet patient complaints persist.
   
5. To verify reasonableness and effectiveness of treatment.
   
6. To determine soft tissue irritation or drainage, especially in chronic pain cases.
   
7. In legal cases, specifically where injuries have occurred and the need for objective findings are present.
   
8. When reassessment of condition is necessary to document improvement, change course or care, or reestabl ish a need for treatment.
   
9. For real versus imagined pain.