Due to the nature of maritime work, there are certain injuries that are more common than others. Because of this, there are certain medical tests we see doctors use to diagnose injured maritime workers. If the company doctor refuses to give you even an MRI or an X-RAY (the most basic of medical tests), then go get a second opinion on your injury. The company doctor may not have your best interests at heart.
If you’re currently seeing a company doctor, make sure he/she performs the following pertinent medical tests to fully explore your injury.
MRI: A magnetic resonance imaging scan (MRI) is one of the most common tests performed to diagnose most injuries to a neck, back, shoulder or knee. An MRI scan shows soft tissue and ligament damage and it provides a much greater detailed view than does a CT scan.
MRIs will diagnose damaged lumbar and cervical discs as well as torn ligaments. If you have suffered any type of injury that has bothered you for more than a few days most likely it is best to get an MRI scan performed. Many company doctors will delay performing an MRI since they may not want to charge your company for the expense. It is important that you insist that all medical testing be performed including MRIs. With today’s technology, an MRI should be considered a basic medical test.
The more traditional MRI is performed in a long tube. There is also a more advanced type of MRI known as a “stand up” MRI scan. Significantly, a stand-up MRI scan is taken while the individual is in a standing position (hence the name). Very often this can produce a more accurate MRI scan which more accurately reflects any type of herniated or damaged lumbar or cervical discs. This is because the scan is taken while the individual is actually placing weight on their lower back and neck.
X-RAY: An X-ray is a basic imaging scan of an individual’s bones. An X-ray does not show soft tissue or ligament/tendon damage nor will it indicate nerve damage.
Most doctors and health facilities will immediately perform an X-ray following an injury. It is very important to understand that X-rays will not diagnose the majority of serious injuries.
X-rays DO NOT reveal:
These types of injuries need to be diagnosed with other tests including MRIs, CT scans, and nerve conduction studies.
CT SCAN: A CT scan (or CAT scan) is a form of enhanced x-ray that can diagnose soft tissue, organ and blood vessel type injuries. Very often a CT scan will be performed after an MRI scan to further diagnose or investigate the individual’s injury. Typically the most helpful CT scans are performed “with contrast.” This means that the individual will drink (or have IV injected) a type of dye before the CT scan is performed. The dye allows the CT scan to give a much more accurate, detailed image of the injured area.
DISCOGRAM/MYELOGRAM: A discogram is a procedure during which dye is injected into a person’s cervical or lumbar discs. The purpose of the test is to determine if the injected dye leaks out or goes beyond the subject disc. A discogram can be a very accurate way to determine the full extent of a person’s injury.
Normal, healthy lumbar and cervical discs will hold the small amount of dye that is injected. This is because a normal, healthy disc is fully enclosed and encapsulated. If a lumbar or cervical disc has been injured, very often this will result in a tear in the disc. When the small amount of dye is injected into the disc it will immediately leak out thus indicating that the disc has a hole or tear in it.
A discogram is often followed by a CT scan which will take images of the disc and the dye in order to visualize if the dye has moved outside of the disc. A myelogram is very similar to a discogram in that dye is injected around the injured (typically) lumbar or cervical area. A CT scan is then performed to view the area and the dye provides an enhanced image of any damage to that area.
ARTHROSCOPIC SURGERY: Although arthroscopic surgery is considered a “surgical” procedure, very often it is used to diagnose injuries which may not be visible with other non-invasive tests. Typically Orthopedics will perform arthroscopic surgery on an individual’s knee and shoulder areas. The purpose of this surgery is to not only repair any damage which may be seen but to also actually identify and visualize damage which may not have appeared on prior MRI and CT testing.
EMG/NERVE CONDUCTION STUDY (NCV): An electromyogram (EMG) is a test that is used to record the electrical activity of muscles. When muscles are active, they produce an electrical current. Typically an EMG is given at the same time as a nerve conduction study. The most common type of nerve conduction study is known as a Nerve Conduction Velocity test. These tests are used to diagnose nerve injuries and muscle damage.
Very often they will be given to individuals who have suffered lower back injuries or neck injuries to diagnose nerve damage which may be occurring in the person’s upper or lower extremities (arms or legs). The NCV will measure how quickly and completely a person’s arm or leg nerve transfer ‘information’, or how quickly and completely they respond. If nerve damage has occurred very often the response will be delayed or incomplete.
It is very important to note that most EMG/NCV tests are not 100 percent accurate. Most physicians will admit that the tests have at least a 10 percent margin of error. Very often individuals with nerve damage will have normal EMG/NCV tests even though they are experiencing nerve damage.
LUMBAR EPIDURAL STEROID INJECTIONS: Also known as “epidural injections” or “steroid injections”, this treatment is a series of injections typically given in a person’s neck or lower back in an attempt to relieve pain from a damaged cervical or lumbar disc. Epidural injections can also be given in an individual’s shoulder area as well as other parts of the body.
Epidural injections are very often described as both therapeutic as well as diagnostic. This means that the injection is given to provide relief to the patient as well as potentially diagnose their injury. Most doctors believe that if the patient receives temporary relief for a period of days or even a few weeks from the injection, this means that the injection was most likely given at the source of the injury. In this way, the injection serves as a diagnostic tool to help the doctor identify the area of injury.
SYMPATHETIC BLOCK: This type of test is performed as both treatment and diagnostic. A sympathetic block is given to a patient to diagnose nerve damage typically into their lower legs, feet or ankles. The basic purpose of the sympathetic block is to “block” the nerve communication from the suspected injury to the person’s brain.
If the sympathetic block is successful, the person will receive relief since the injured part of the body temporarily will not communicate with the individual’s brain. This result indicates to the doctor that the person is suffering from nerve damage at the point of the injury. If the sympathetic block is successful (and very often a series of them are performed), the doctor may consider permanently “disconnecting” that nerve such that it will no longer send messages of pain to the person’s brain.
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