Patient History and Physical Exam | Spine Differential Diagnosis | Sports Medicine Doctor | Vail, CO

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This is the most important and exciting part other than a physical exam. Dr. Corenman discusses a patient’s history, physical examinations, and differential diagnosis. How do you glean the information from a patient to figure out what’s wrong? You now know what can go wrong in the spine, but the question is how do you get that information out of the patient? You must ask the appropriate questions to identify pain generators. Here are the 6 factors to look for:

1. Where is the pain?
2. What percentage of pain is located where?
3. What is the pain intensity at each location (VAS)?
4. What activities increase or decrease with pain?
5. What is the history of onset?
What is the impairment to the patient?

By using the appropriate medical forms and reviewing a patient’s symptoms, this will help a doctor understand how previous conditions can create or affect the current disorder. For surgeons, this can be helpful for recovery and healing purposes.

The pain diagram is the single most valuable tool for patient history evaluation. Patients may draw old pain patterns from the initial symptoms. No pain percentages or mechanical provocations are noted.

How do you split up the pain into sections? You must know what structures are capable of causing this pain. Ask Questions! Patients commonly confuse terms of location. Pain diagrams say nothing of weakness, loss of function or activities that trigger or relieve pain.

Here are some additional helpful tips:
-Use visual analog scales to help patients think about their pain and symptoms.
-Use percentages to differentiate pain regions
-What activities induce pain? Certain structures are aggravated by flexion vs. extension loading maneuvers of impact activities
-Examine the quality and temporal nature of the pain
-If you start to suspect a disorder, ask specific questions regarding associated symptoms

One of Dr. Corenman’s favorite quote from Voltaire is: “The lower back is at the crossroads where the psych meets the soma.” Always ask the four depressions questions: Do they have Anhedonia, insomnia, lethargy or irritability.

Other topics that are covered include: leg pain characteristics, weakness questions, bowel and bladder (B/B) function, night pain, unreliable historian (some patients simply don’t pay attention to the onset of pain until it becomes overwhelming), honing your diagnostic skills, instability symptoms, quality of pain, “numbing pain, “burning pain,” “electrical pain,” “cramps,” fasciculations, “skip pain,” improving radiculopathy “centralization” phenomenon, bone pain, diagnosis requirements, and S1, L5, L4, L3, L1 or L2 Radiculopathy.

Lastly, Dr. Corenman covers a few case reports such as a Pars fracture in a 12-year-old patient with somatization. He discuss diffusing pain patterns, neurogenic claudication confused pain picture, foraminal collapse, lateral recess stenosis, prolonged presence of foraminal stenosis (may have constant pain), instability or transitional pain, peripheral neuropathy, myelopathy, paper clip test, and “looking backwards” technique.

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With more than 30 years of experience, Donald Corenman, MD, DC, is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. His training as a Doctor of Chiropractic early in his career did not satisfy his desire for a deep understanding of the mechanics of the spine. This led him to medical school where he completed his Doctor of Medicine, Orthopedic Surgery Residency and Spine Surgery Fellowship. His study of spinal disorders and deformities brought him to Vail, Colorado where he joined The Steadman Clinic in 1994. With personalized clinical care a cornerstone of Dr. Corenman’s practice, he has been awarded the “Top 10 Doctor Award”, “Patient’s Choice Award”, “Compassionate Doctor Recognition” and is consistently recognized by Becker’s Spine Review in “Top Spine Surgeons to Know.”

Dr. Corenman has published two books: for patients, “Everything You Wanted to Know About the Back: A Consumers Guide to the Diagnosis and Treatment of Lower Back Pain” and for the medical community, “The Clinician’s Guidebook to Lumbar Spine Disorders: Diagnosis & Treatment”. He is passionate about educating patients on spine anatomy and disorders, so they have the ability to partner with their physicians in finding the most effective treatment for their back pain and disorders.