From the Guidelines
For an older man presenting with arm spasms and hand pain, radiography is usually the appropriate initial imaging study to evaluate chronic hand or wrist pain. This recommendation is based on the most recent guidelines from the American College of Radiology, as outlined in the 2023 update on ACR Appropriateness Criteria for chronic hand and wrist pain 1.
When considering the diagnostic approach, it's essential to start with a comprehensive evaluation that may include a neurological examination and basic laboratory tests to rule out systemic causes. However, imaging with radiography is typically the first step in the diagnostic algorithm for chronic hand or wrist pain, as it can help identify or rule out bone-related issues such as fractures, arthritis, or other bony abnormalities.
If the radiographs are normal or show nonspecific arthritis, MRI without IV contrast is usually appropriate as the next imaging study for chronic hand pain, while for chronic wrist pain, either MR arthrography or MRI without IV contrast can be considered as equivalent alternatives 1. These imaging modalities can provide detailed information about soft tissue, nerve, and joint conditions that might not be visible on radiographs.
Additional tests such as nerve conduction studies, electromyography (EMG), and other specialized imaging or laboratory tests may be necessary based on the initial findings and clinical suspicion of specific conditions like nerve compression, peripheral neuropathy, or systemic diseases.
The choice of subsequent tests should be guided by the clinical presentation and the results of the initial diagnostic workup, with the goal of achieving an accurate diagnosis that can inform effective treatment planning and improve patient outcomes.
From the Research
Necessary Tests for Diagnosis
To diagnose an older man presenting with arm spasms and hand pain, several tests may be necessary. The diagnosis can be established by:
- History and physical examination, as stated in the study 2
- Magnetic resonance imaging (MRI) to assess cervical spinal function and quality of life, as mentioned in the study 3
- Radiographic parameters such as C0-C2 Cobb angle, C2-C7 Cobb angle, T1 slope, neck tilt, C2-C7 sagittal vertical axis, and T1S-CL, as measured in the study 3
- Functional assessments such as the visual analog scale (VAS), neck disability index (NDI), and modified Japanese Orthopedic Association (mJOA) score, as used in the study 3
Additional Diagnostic Tools
Other diagnostic tools that may be useful in diagnosing cervical spondylosis and related conditions include:
- Diffusion tensor imaging (DTI) to assess white matter damage, as mentioned in the study 4
- Voxel-based morphometry (VBM) to assess gray matter loss, as mentioned in the study 4
- Magnetic resonance spectroscopy (MRS) to assess metabolic changes, as mentioned in the study 4
- Spinal cord perfusion MR imaging to assess ischemia and hypoxia, as mentioned in the study 5
Importance of Diagnostic Tests
These diagnostic tests are important in establishing the diagnosis and assessing the severity of symptoms in patients with cervical spondylosis and related conditions. For example, the study 3 found that the degree of spinal cord compression is an independent risk factor for severe symptoms, and that when the degree of spinal cord compression exceeds 30%, the clinical symptoms are more severe. Similarly, the study 5 found that spinal cord perfusion MR imaging can implicate both ischemia and hypoxia in the pathogenesis of cervical spondylosis.