Tests
Tests to consider
plain x-rays of spine, bones, and/or joints
Test
Considered in patients with traumatic pain, spine pain, or evidence of joint dysfunction. Degenerative changes are common with aging.
Result
identifies osteoporosis, fractures, osteoarthritis, lytic bone lesions, arthritic changes
MRI of spine
Test
Reserved for patients with evidence of neurologic dysfunction suggesting specific level(s) of neural dysfunction, or in patients with history suggesting lumbar stenosis (pain with prolonged walking, relieved with stooping or sitting).
False-positives are common. For example, half of lumbar spine MRIs in asymptomatic adults show disc bulging, with herniation in 1 in 4 asymptomatic adults.[44][45] MRI abnormalities in asymptomatic adults do not predict the later development of clinical low back pain symptoms.[46]
Result
identifies disc herniation with nerve root impingement, lumbar stenosis, and pathologic causes of pain
electromyogram and nerve conduction studies
Test
Considered in patients in whom examination fails to localize specific nerve pathology, to help identify level of nerve dysfunction.
Result
help identify and differentiate between peripheral causes of neuropathic pain, such as peripheral neuropathy, and radiculopathy
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