Diagnostic Tools

Vascular Tests

Plethysmography

Doppler and plethysmography measure both the quantitative and qualitative flow of blood in the arteries and capillary beds. In short, they determine if you have an adequate blood flow in the area the doctor is testing. Most commonly used for disorders such as Peripheral Arterial Disease (PAD) or "Restless Leg Syndrome" the tests are both non-invasive and painless. The tests are also useful in determining whether symptoms such as pain, tingling, or numbness, have a vascular component or cause, in addition to a multitude of other causations such as a "pinched nerve" (neurological component). People are often unaware, that after a traumatic injury, such as an automobile accident, that many of their symptoms may have a vascular component, which, if left undiagnosed or untreated, will often get worse with time. Many times these people present with headaches or coldness in their hands or feet. The upper two videos show the difference between a normal plethysmography (on top) and a patient that has decreased blood flow in the feet after experiencing a motor vehicle accident five years ago and has been complaining of "coldness" and "tingling" in the feet to their primary physician for almost eighteen months before being referred to our clinic. You will notice that the wave height is smaller in the second (bottom test). Two things to note. First, the sensitivity setting (middle row of buttons) is set at 5 (blue button) in both views so as not to distort results. Second, you should notice the absence of sound in the lower test as the blood flow at the 5 sensitivity was below the threshold to trigger the audio control.

Vascular Tests

Arterial/Venous Doppler

The lower two videos show a normal arterial doppler study (on top) and an abnormal study of a patient that complained of a throbbing pain and numbness in the right hand. He was diagnosed with a "pinched nerve" by his physician (X-ray and MRI showed a pinched nerve) and experienced about 40% relief with the care he received. However, he continued to experience symptoms and was referred to our office by a previous patient of ours and his neighbor. The vascular studies showed that there was also a vascular component to his complaints. After changing the treatment slightly the symptoms disappeared after several months and he remains asymptomatic.

Although similar in appearance to the plethysmography test there are difference which must be interpreted by the physician. In cases where there is blockage, or occlusion of an artery there may be little or no waveform. The good news is that the body usually has "collateral" circulation which means that when the flow of blood is blocked in one direction, the body usually finds a way to shunt the necessary blood through other, or collateral vessels. Without this collateral circulation any blockage, no matter small, would have disastrous effects.