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Re: Mountain Biking
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Re: Mountain Biking - July 11, 2005 5:26:00 AM
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chiroortho
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Gosh guys, you're seeing things better than me because I don't see a thing wrong with this guy's shoulder. A little supraspinatus tendinosis, a tiny traction spur on the 2nd rib, no dislocations anywhere, no fractures.
If I'm wrong I'll think of something to blame it on.
Those film markers are traditionally called 'Mitchell markers'.
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Greg Priest, DC, DABCO
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Re: Mountain Biking - July 12, 2005 2:55:00 AM
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Jeep
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Chirortho-
I think there is confusion between "findings" and "diagnosis". X-rays are rarely "diagnostic". They must, in almost all cases, be clinically correlated(history, exam etc.).
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Re: Mountain Biking - July 12, 2005 6:21:00 AM
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JLS_PT_OCS
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Great point, Jeep.
That's why these cases are so interesting...we have to go the films only, very little history, and no exam. It really sharpens the lens, but I have noticed a tendency (for me anyway) to over-interpret.
Guess that's why I'm not a radiologist. :)
J
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Jason Silvernail DPT, OCS, CSCS
Homo Vegetus
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko, Writer and Physical Therapist
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Re: Mountain Biking - July 12, 2005 12:24:00 PM
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chiroortho
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Sorry, don't quite follow you here. I listed some findings, not a diagnosis, unless 'no fractures or dislocations' is a diagnosis.
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Greg Priest, DC, DABCO
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Re: Mountain Biking - July 12, 2005 2:25:00 PM
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Jeep
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Sorry for the confusion Chirortho- my post was not directed AT you, but a comment sorta commenting on your comment---------Does that make it any clearer? LOL!
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Re: Mountain Biking - July 12, 2005 5:11:00 PM
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jma
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Hmmm, what are the findings then Alex? Should be interesting.
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Re: Mountain Biking - July 19, 2005 3:53:00 AM
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chiroortho
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Hi Alex,
Couple of points:
1. The Hill-Sachs defect is essentially a small divot in the posterosuperior aspect of the humeral head that is usually seen after repeated anterior dislocations of the glenohumeral joint. It develops due to the impact of the anterior glenoid rim on the posterosuperior humeral head. See http://orthopedics.about.com/cs/othershoulder/g/hillsachs.htm Honestly it's odd that this would be read on these films, particularly since there was apparently no dislocation when the guy fell...VERY odd.
2. The yellow circle is not pointing to the subchondral cyst. The SC is actually in the glenoid, a small radiolucent circle that can be seen on both images just to the right of the humeral head in the glenoid (follow the edge of the humeral head about halfway down and you'll see it in the glenoid). Your circle is pointing to the purported bone fragment from the Hill Sachs lesion. Honestly it looks to me to be SS tendon calcification (calcific tendinosis) but it's certainly possible that it's a bone fragment. If so, it would have to suggest that the guy's shoulder dislocated when he fell then relocated on its own.
By the way subchondral cysts generally suggest DJD but may also be found in people for no apparent pathologic reason in which case they may be considered to be of limited clinical significance. Here's an example of a subchondral cyst in a dysplastic hip: http://www.totaljoints.info/subchondral_cyst.jpg
Alex, if you get a chance, run this by the radiologist and see what he says. To be candid, this is an ODD reading from the radiologist.
Have a great day and thanks for all you do here. Let me know if you talk to the radiologist about my comments. I'd be interested in how he responds.
Greg
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Greg Priest, DC, DABCO
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Re: Mountain Biking - July 19, 2005 5:52:00 AM
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Alex Brenner PT MPT OCS
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Thanks Greg. You are correct. I have missed labeled the diagrams. The reason I have taken so long to post the findings were that I was also taken back by his reading. I was really having troubles seeing these but he felt pretty certain about them. I will run these again by a separate radiologist. Thanks again for the information.
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Alex Brenner, PT, MPT, OCS
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Re: Mountain Biking - July 19, 2005 8:09:00 AM
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Synergy
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Very interesting! I was actually going to suggest a Hill-Sachs lesion, but given my inexperience with reading films, I hesitated to do so.
Greg, the subchondral cyst you're referring to...are you talking about the pencil eraser-sized 'grey circle' just to the right of the humeral head?
Thanks! Keep 'em coming Alex. :)
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Chris Adams, PT, MPT
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Re: Mountain Biking - July 19, 2005 7:59:00 PM
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chiroortho
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Chris,
Yes.
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Greg Priest, DC, DABCO
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Re: Mountain Biking - July 20, 2005 4:30:00 AM
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Synergy
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Greg,
Thanks. :)
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Chris Adams, PT, MPT
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Re: Mountain Biking - July 22, 2005 6:45:00 AM
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SJBird55
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Hey, Alex.. how come that clavicle looks like it's in the wrong position? What's the scoop on that?
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Re: Mountain Biking - July 25, 2005 6:40:00 PM
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Dr.Wagner
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It is the angle of the x ray beam that distorts the view of the film and the clavicle.
Which gives me a good idea.
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Re: Mountain Biking - July 26, 2005 3:20:00 PM
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SJBird55
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Ah... why would anyone want the pic distorted? Geesh that is irritating (at least to me).
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Re: Mountain Biking - July 27, 2005 3:44:00 AM
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JLS_PT_OCS
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Rad tech took a poor film. The QI process at the radiology dept didn't catch it.
J
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Jason Silvernail DPT, OCS, CSCS
Homo Vegetus
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko, Writer and Physical Therapist
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Re: Mountain Biking - July 27, 2005 6:12:00 AM
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Alex Brenner PT MPT OCS
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Hey J, were the radiology techs like "derr"? :)
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Alex Brenner, PT, MPT, OCS
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Re: Mountain Biking - July 27, 2005 6:58:00 AM
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JLS_PT_OCS
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Well, of course! We are talking about the military, aren't we? Haven't you heard, they're all stupid and provide inferior care!
Nice use of the film for educational purposes, though, us "derr" health care providers need all the help we can get, I guess...
:)
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
Homo Vegetus
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko, Writer and Physical Therapist
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Re: Mountain Biking - July 27, 2005 7:21:00 AM
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Shill
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Did I miss what "derr" means somewhere?
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Steve Hill PT
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Re: Mountain Biking - July 27, 2005 8:35:00 AM
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karmzack
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"derr" - see the DVT thread in the ortho section
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Zack Solomon MPT, OCS, CSCS
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The yellow arrow represents the small Hill Sachs lesion. 
