A patient came in the other day with an MRI report in hand that stated that she had several herniated discs in her neck. As a therapist I will always read MRI reports with a grain of salt. There have been many times in my career where an MRI stated conditions that were not necessarily the cause of the problem. Clinicians need to be careful not to assume that an MRI is the "end all be all" in diagnosis. An MRI is only another piece of a larger clinical puzzle. Too many times an MRI report will lead therapist and other clinicians, barking up the wrong tree.
The patient reported that she has numbness and tingling in her right hand that is inconsistent and increases throughout the day.
With this information some therapist might just assume that this numbness is caused by the herniated discs in her neck. Herniated discs in the neck are often the causes of this kind of numbness, however, it is very important to review several clinical tests to confirm this assumption.
First we need to discuss the patient's lifestyle. This patient was an office worker who sits at desk for many hours. She also answers the phone on the right side and stated she feels the most symptoms when sitting at work. After asking several more questions it was clear to me that this patient works in a very stressful environment and works on the computer for many hours without breaks.
After asking questions, looking at the patient's posture it was seen that she sits with her shoulders slouched with her head pushed forward.
The first clinical test we must do is the compression test, where we compress the spine in sitting to see if it increases symptoms. If it does, it is a signs that a neck disc herniation is the culprit. For this patient, this test did not increase symptoms. The next test is the distraction test which consists of pulling the head up when the patient is sitting. If this decreases symptoms it is another sign that a disc herniation is a possible cause of symptoms. For this patient she felt no difference with the distraction test.
Because of this results we can move to another set of tests to check for thoracic outlet syndrome. This diagnosis I can discuss in a future blog. As we went through these test I saw that this patient was actually experiencing numbness in her hand because of thoracic outlet syndrome. This assertion was confirmed by another therapist and neurologist that the patient saw a few weeks later.
If I assumed that the disc herniation shown in the MRI was the cause of this patient's symptom we would have wasted valuable time and energy (as well as money). So, although MRIs are a valuable tool, remember that they are only a piece of the puzzle.
