Osteoarthritis medical diagnosis
Any patient experiencing
back pain or stiffness in a joint or joints for more
than two weeks should see his or her physician for an
evaluation. The evaluation usually consists of a discussion
of symptoms and a detailed medical history, a physical
examination and—if osteoarthritis is suspected—a series
of x rays. Other tests (blood tests, MRI or CT scans)
may be performed to confirm the presence of spinal arthritis
or to rule out other conditions that can cause similar symptoms,
such as a tumor, infection, fracture, or other types
of arthritis.
Diagnosing spinal osteoarthritis
Typically, the physician will
use a combination of findings from a patient’s
medical history, physical exam and medical tests to
accurately diagnose whether a patient has osteoarthritis. An accurate
diagnosis is very important for guiding the selection
of treatment options—and for actually helping relieve
the pain and discomfort associated with the patient’s condition.
Medical history. The patient will be asked to describe
his or her symptoms, such as a description of the pain, stiffness and
joint function, when and how the symptoms started, and how the symptoms
have changed over time. The patient should also discuss how the
symptoms affect his or her everyday life and work activities. The
doctor also needs to know about the patient’s other medical conditions,
current medications, past experience with other treatments, family history,
and general lifestyle habits (such as alcohol intake, smoking, etc.). When
dealing with pain problems, the doctor is likely to ask key questions
related to those things that reliably cause or aggravate the pain and
those that reliably bring relief or prevent the pain. Other questions
may relate to certain lifestyle topics, such as exercise,
nutrition and activities for diversion, sports, etc.
Physical examination. The doctor will conduct a physical
exam to assess the patient’s overall general health, musculoskeletal
status, nerve function, reflexes and direct evaluation of the problematic
joints in the back. The doctor will be looking at muscle strength,
flexibility, and the patient’s ability to carry out daily living
activities such as walking, bending, and reaching. The patient
may also be asked to perform some exercises to test
range of motion and determine whether pain worsens during any particular
type of movement.
X-rays. The doctor will likely order an x-ray to see if
there is joint damage and how much joint damage has occurred. The
x-ray can show cartilage loss, bone damage, and the presence and location
of bone spurs. X-rays are also useful in helping to exclude other
causes of pain and to better inform possible considerations about surgery. However,
it is important to keep in mind that what shows up in an x-ray may not
correlate to the presence or absence of osteoarthritis and associated
pain. For example, most people over age 60 have degenerative changes
in their spine consistent with osteoarthritis, but for perhaps 85% of
them there is no pain or stiffness. Conversely, an x-ray conducted
during the early stages of osteoarthritis may not yet show any visible
damage to the joints. For all these reasons, the clinical history
and physical examination are essential to arriving
at an accurate clinical diagnosis and plan of treatment.
Other tests may also be used to rule out conditions other than osteoarthritis
that may be causing the patient’s symptoms. For example,
blood tests are used to exclude diseases that can cause
secondary osteoarthritis or other types of arthritis
that simulate osteoarthritis. Joint aspiration, where fluid is drawn
from the joints through a needle for examination, can help rule out conditions
such as infections or gout.
Additional tests that may be needed to rule out other causes of pain
or to identify the presence of arthritis with more sophistication than
an x-ray can include:
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A radioactive bone scan, used to rule out
inflammation, a tumor, infection or a small fracture.
With a bone scan, the radioactive ‘tracer’ material
is injected intravenously and then is concentrated
by the body where there is high metabolism or bone
turnover. If something suspicious is found on the
bone scan, it is usually followed by a CT or MRI
scan to distinguish what the bone lesion might
represent, since the bone scan alone cannot distinguish
among tumors, infections or fractures.
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A CT scan may be used to better show the
adequacy of the spinal canal and surrounding structures.
A CT scan may also include myelography, where an
x-ray contrast dye is injected into the spinal column
to show structures such as a bulging disc or bone
spur possibly pressing on the spinal cord or nerves.
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The MRI or magnetic resonance imaging scan,
is a very sophisticated imaging method that can
show great anatomic details of the spinal cord, nerve
roots, discs, ligaments and surrounding tissues
and spaces. Most MRI studies require the patient
to lie flat in a tube for about 40 minutes, although
open frame and even standing MRI scanners exist
and seem particularly appropriate for patients having
claustrophobia (fear of tight spaces). MRI
scans can be adjusted to show different tissues
including their water content, important in determining disc
degeneration, infections or tumors. The goal of
all diagnostic studies is to discover patterns or confirmations
between the various tests that point to a clear
diagnosis among various possible ones.
The key is to diagnose the condition causing the patient’s pain
and disability and to guide appropriate treatment, including psychological,
physical, medical and/or surgical. Diagnosis is a detective hunt
for causes and effects with the goal of improved treatment.
By: Charles D. Ray, MD
June 7, 2005
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