How to Make a Differential Diagnonsis
- Posted on: Mar 1 2017
When treating patients injured in accidents (i.e. work, automobile, slip and falls, construction), it is essential for the doctor to make a clear,
concise, differential diagnosis. Many serious injuries sustained by accident victims (especially spine related) are often difficult to diagnose and can mimic other potential conditions. A differential diagnosis is defined as the distinguishing of a particular disease or condition from others that present similar clinical features.
When a patient is involved in an accident and sustains injuries to the cervical or lumbar spine (or both) it is often difficult to attain an accurate diagnosis. Since nerves travel from the neck down through the arms and into the hand, a pinched nerve in the neck will often cause pain into the arm and/or hand. Nerves in the lower back leave the spine and travel into the buttock, down the leg and into the foot. A pinched nerve in the lower back will often cause pain the buttock, leg, and/or foot. How does Dr. Mollins “differentiate” between arm injury/neck injury or leg injury/low back injury? The following is how Dr. Mollins goes about making an accurate differential diagnosis.
- History – A careful history is vital in making a proper diagnosis. Dr. Mollins is aware that when it comes to accidents, knowing the mechanism of how that accident occurred is extremely important. Dr. Mollins will always ask the patient to specifically describe the accident. By understanding the mechanism of the accident, Dr. Mollins will have a better insight as to what the particular injury may be. History is the first way Dr. Mollins can differentially diagnose spinal injury vs extremity injury.
- Physical Examination – The single most important element the diagnosis of an injured patient is the physical exam. In order to make a differential diagnosis, physical examination is crucial. There are two parts to the examination when assessing a differential diagnosis:
A – Neurological evaluation – This is a systemic examination that surveys the functionality of nerves delivering sensory information and motor commands. When neck and back pain are involved (making a differential diagnosis) a neurological examination is essential. Reflex testing, sensation, and muscle strength are just some of the tests performed. The neurological evaluation performed by Dr. Mollins can help determine whether the injured area is the spine or extremity.
B – Orthopedic Tests – These tests enable Dr. Mollins to identify a specific area of injury to determine the differential diagnosis of the injured individual. Since orthopedic testing is specific for a particular region (like the cervical or lumbar spine, upper & lower extremities), these specific tests enable us to differential between neck/arm pain and lumbar/leg pain.
- Diagnostic Testing – This type of testing provides objective evaluation of the specific injured region. Diagnostic testing such as general radiology (x-rays) and/or MRI study provide a structural, visual picture of the regions involved that may be potentially injured. EMG/NCV study provides functional testing of the involved regions that are potentially injured. Utilizing diagnostic testing is extremely valuable in providing a differential diagnosis and enables Dr. Mollins to differentiate between cervical spine /arm injury and/or lumbar spine/leg injury.
By utilizing the above methods, Dr. Mollins is able to provide an accurate differential diagnosis. A concise diagnosis then enables Dr. Mollins to place his patients on a treatment regimen which will result in his patients achieving wellness!