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Howard B. Cotler
MD, FACS, FAAOS
Howard B. Cotler, MD, is board certified and recertified in orthopaedic surgery. He is a fellow of the American Academy of Orthopedic Surgery and the American College of Surgeons.

Diagnostic Tests

About Our Diagnostic tests

Orthopedic and Diagnostic tests contribute to an accurate diagnosis of musculoskeletal injuries and conditions. Orthopedic surgeons use a variety of diagnostic tests to help identify the specific nature of your musculoskeletal injury or condition.Orthopedists also use results from these tests to plan an appropriate course of treatment. Here are some of the most frequently used diagnostic tests for musculoskeletal injuries and conditions.

Images of Dr. Cotler helping patients

Blood Test

As part of your examination, your Orthopedist may order a variety of blood tests.

Some conditions, such as rheumatoid arthritis, may be identified by the presence of a specific substance in your blood. You may be asked to fast prior to the exam.

Usually a blood test is a simple matter that involves withdrawing a small amount of blood from your arm.
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Diagnostic Testing

Bone Scan

Diagnostic TestTwo very different kinds of tests may be called bone scans.

The first type tests the density of the bone and is used to diagnose osteoporosis. This type of bone scan uses narrow X-ray beams or ultrasound to see how solid the bone is. No preparation is required for this test, which takes only a few minutes and has no side effects. (See Dual-Photon Absorptiometry, Dual-Energy X-ray Absorptiometry, and Peripheral Bone Density Testing.)

There are three different types of injections that can be administered intravenously, each with a specific condition they will diagnose.

  • Technetium –This bone scan is sensitive to areas where there is unusual bone rebuilding activity and will bind itself to cells that build bone. A bone scan will pick up this information and a brighter area on the results indicating a possible bone fracture or tumor.
  • Indium –During this bone scan white blood cells are taken from the patient, infused with indium, and then injected intravenously back into the patient. The new white blood cells will then gather in areas with relatively new infection allowing them to be imaged on the bone scan.
  • Gallium –Gallium binds itself to areas of infection or rapid cell division in the body. It is generally used to find or locate chronic infections and bind to them, allowing the infection to be imaged on a bone scan.

The bone scan itself is performed about three hours later, which gives the bone time to absorb the injection.

As you lay on a table, a special nuclear camera takes a picture of your entire body. This process takes 30 to 90 minutes. Areas of abnormal bone formation activity will appear brighter than the rest of the skeleton.

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Discography

Discography is a test used to determine whether the discs, the cushioning pads that separate the bones of the spine, are the source of back pain.

It may be performed before surgery to positively identify the painful disc(s).

Before the procedure begins, you will be given antibiotics and relaxation medications through an IV line. Medication is used to numb the skin over the test site.

During the procedure, the doctor inserts a needle into one or more discs and injects a contrast dye. You’ll feel pain when the dye is introduced into the problem disc.

Afterward, a CT scan will show any changes in the disc size or shape. You may experience some muscle discomfort after the procedure; your doctor can prescribe pain relievers to ease the discomfort.

No special preparations are required for this test. No fasting is required. However, you should not take any pain relievers or anti-inflammatory medications on the day of the procedure.The amount of radioactivity absorbed during the scan is minimal, and there are usually no side effects.
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Doppler Ultrasound

An Orthopaedist who suspects that you have a blockage in the blood vessels of your legs or arms may prescribe an ultrasound test.

An ultrasound uses high-frequency sound waves that echo off the body. This creates a picture of the blood vessels. The Doppler audio system transmits the “swishing” sound of the blood flow. This is a noninvasive test.

A clear jelly is applied to the skin over the blood vessels being tested. The technician uses a sensor that looks similar to a microphone.

The sensor is placed against the skin and gently moved across the area being tested. The technician may apply pressure every few inches to see if the blood vessels change their shape or to get a better view of the ultrasound image. The test takes about 30 minutes, and most people experience no pain or discomfort.


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Electromyography

An electromyography (EMG) records and analyzes the electrical activity in your muscles. It is used to learn more about the functioning of nerves in the arms and legs. For example, a fracture of the upper arm bone (humerus) may tear or pinch the radial nerve.

An EMG can be used to identify the damage if nerve function doesn’t return within 4 months of the injury.

During an EMG, small, thin needles are placed in the muscle to record the electrical activity. When the needles are inserted, you may feel some pain and discomfort. The doctor will ask you to relax the muscle and then to tense it slightly.

The electrical signals generated by your muscle are broadcast on a TV-like screen

If you are taking blood-thinning medications, have lung disease or are at risk for infection, tell the physician who is conducting the test. On the day of the test, do not put any lotions or creams on the area to be tested and do not wear any jewelry.
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Laboratory Studies

Laboratory studies of blood, urine or joint (synovial) fluids are used to identify the presence and amount of chemicals, proteins, and other substances.

Your doctor may order various laboratory studies depending on what he or she finds during the initial examination.

For example, laboratory studies can identify the amount of uric acid in the blood, which is an indicator of gout.

A high white blood cell count in joint fluid may indicate severe inflammation or infection. Laboratory tests are usually required before surgeries to identify medical abnormalities.
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Magnetic Resonance Imaging (MRI)

Spinal instrumentation is used in conjunction with a spinal fusion to help increase your chances of a successful fusion. At Gulf Coast Spine Care we only use state-of-the-art implants.

It can be used to help diagnose torn muscles, ligaments and cartilage, Heriated disks, hip or pelvic problems and other conditions.

As with a CT scan, you lie on a table that slides into the tube-shaped MRI scanner. The MRI creates a magnetic field around you, then pulses radio waves to the area of your body to be pictured.

The radio waves cause your tissues to resonate. A computer records the rate at which your body’s various parts (tendons, ligaments, nerves) give off these vibrations, and translates the data into a detailed, two-dimensional picture.

You won’t feel any pain while undergoing an MRI, but the machine may be noisy. An MRI takes 30 to 90 minutes, and is not available at all hospitals. It is very important to let your doctor and the radiology team know if you have a pacemaker or any other medical implants, clips, or metal objects in your body before your study.
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Muscle Tests

Because muscles are soft tissues, they do not appear on X-rays. So muscle testing is an important part of the physical examination.

Weakness in a muscle may indicate injury to the tendons that connect the muscle to bone, injury to the nerves that enervate the muscle, or a generalized weakness of the muscle itself from disuse.

To test the strength of your muscles, your physician may ask you to move in certain ways while he or she applies a resistive force. For example, your physician may ask you to sit in a chair and then attempt to raise one knee as the doctor presses down on your upper leg.

Or test the strength of your muscles, your physician may ask you to move in certain ways while he or she applies a resistive force. For example, your physician may ask you to sit in a chair and then attempt to raise one knee as the doctor presses down on your upper leg.
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Nerve Conduction Study (NCS)

Nerve conduction studies are often done along with an electromyogram to determine if a nerve is functioning normally.

It may be recommended if you have symptoms of carpal tunnel syndrome or ulnar nerve entrapment.

The doctor conducting the test will tape wires (electrodes) to the skin in various places along the nerve pathway. Then the doctor stimulates the nerve with an electric current.

As the current travels down the nerve pathway, the electrodes placed along the way capture the signal and measure its speed.

In healthy nerves, electrical signals can travel at speeds of up to 120 miles per hour.

If the nerve is damaged, however, the signal will be slower and weaker. By stimulating the nerve at various places, the doctor can determine the specific site of the injury.

Nerve conduction studies also may be used during treatment to test the progress being made. Although you may initially be startled by the suddenness of the stimulation, it is not usually painful and most people are comfortable during the testing procedure.The shock is similar to one received when you touch a doorknob after walking across
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Palpation

Palpation means touching. During the physical examination, your doctor may feel your joints to see if they are warm or swollen, signs of inflammation. He or she may apply pressure to a muscle or joint to identify an area of tenderness. Palpation can also be used to identify the location of growths such as tumors or cysts.

A physician may place a hand over a joint and ask you to move the joint, particularly if you complain of a “popping” or “snapping” sensation. This enables the physician to feel the tendons as they move over the joint. If you have a joint dislocation, the doctor may palpate the area before attempting to realign the bones
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Peripheral Bone Density Testing

You’ve probably seen portable devices that determine bone mineral density at sites such as the wrist, the fingers, or the heel. Because they are small and cost less than other methods of testing bone density, these devices are frequently used for large-scale osteoporosis screenings. However, bone density varies among different skeletal sites, and bone density may be normal at one site and low at another site.

Because these devices only test bone density in a specific site, they may miss indications of osteoporosis in other skeletal areas. In early postmenopausal years, bone density in the spine decreases first, and bone density at other sites does not begin to coincide until about age 70. Although these devices are considered accurate, they may not be precise enough to monitor patients undergoing treatment for osteoporosis.

Because these devices only test bone density in a specific site, they may miss indications of osteoporosis in other skeletal areas. In early postmenopausal years, bone density in the spine decreases first, and bone density at other sites does not begin to coincide until about age 70.

Although these devices are considered accurate, they may not be precise enough to monitor patients undergoing treatment for osteoporosis.So, even if your have peripheral bone density is “normal,” you may still need a more extensive bone density test to rule out osteoporosis.
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Physical Examination(NCS)

Your physician can tell a lot about your health simply by looking at you.

Obvious signs and symptoms include weak (atrophied) or asymmetrical muscles, improper alignment, swelling, changes in skin color (such as bruises or redness that might indicate inflammation) and growths such as cysts, calluses or corns.

During the physical examination, your doctor may feel your joints to see if they are warm or swollen, signs of inflammation. He or she may apply pressure to a muscle or joint to identify an area of tenderness. Palpation can also be used to identify the location of growths such as tumors or cysts.
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Radiographs (X-rays)

X-rays (radiographs) are the most common and widely available diagnostic imaging technique. Because they are small and cost less than other methods of testing bone density, these devices are frequently used for large-scale osteoporosis screenings. However, bone density varies among different skeletal sites, and bone density may be normal at one site and low at another site.

X-rays are always used for fractures and joint dislocations, and may also be recommended if your doctor suspects damage to a bone or joint from other conditions such as arthritis or osteonecrosis (bone cell death).

The part of your body being pictured is positioned between the X-ray machine and photographic film. As you hold still, the machine briefly sends electromagnetic waves (radiation) through your body. This exposes the film, creating a picture of your internal structure. The level of radiation exposure from X-rays is minimal, but your doctor will take special precautions if you are pregnant. Bones, tumors and other dense matter appear white or light because they absorb the radiation.

Soft tissues and breaks in bone let radiation pass through, making these parts look darker. Sometimes, to make certain organs stand out in the picture, you are asked to drink barium sulfate or be injected with a dye. Several X-rays from different angles may be neededIf you have a fracture in one limb, your doctor may want a comparison X-ray of your uninjured limb. Your X-ray session will probably take 10 to 15 minutes; no specific preparations are required.
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Ultrasonography

This is the same kind of test as the Doppler ultrasound, but without the audio effect.
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Venography

AVenography is used to determine whether you have a blood clot in your leg, a condition called deep vein thrombosis. This is a serious condition because if the clot breaks free, it could travel to your lungs, creating a potentially fatal condition called pulmonary embolism.

In this test, a contrast solution (or dye) is slowly injected into your leg as you lie on a tilting X-ray table. The dye causes a warm, flushed feeling in the leg and might also make you feel nauseous. X-rays are taken to identify the location of the clot. After the test, a clear fluid is injected in the same spot to clear the dye from your veins. The test takes less than an hour and can be done on an outpatient basis. After the test, you should drink plenty of fluids to flush the remaining contrast solution from your system.

You may be asked to fast or drink only clear liquids for 4 hours before the test. Because the contrast solution contains iodine, notify your doctor if you are allergic or have had a previous bad reaction to a contrast solution. You should not have venography if you have kidney (renal) problems.

You may experience some soreness, but notify your doctor if there is swelling, redness, pain or fever.Venographs are accurate diagnostic tests but are an invasive study so your doctor may try to use a noninvasive study first to identify a deep vein thrombosis.
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Personal Treatment Plan