Re: low back pain with radiculitis (Full Version)

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SJBird55 -> Re: low back pain with radiculitis (August 23, 2005 3:04:00 PM)

LOL geesh... but the problem is that if the person is questioned about constipation and the person is there for radiographs, I highly doubt that the constipation is going to be resolved in an expedited manner. Well, let's just say if I were the tech, I know I wouldn't be doing anything about clogged plumbing.



jma -> Re: low back pain with radiculitis (August 23, 2005 3:08:00 PM)

Interested to know what the findings were.



chiroortho -> Re: low back pain with radiculitis (August 23, 2005 3:10:00 PM)

[QUOTE]other imaging modalities could be employed- namely CT/MRI.[/QUOTE]Great point. For weird-looking anomalies, coupled with a patient with pain (especially radicular symptoms), I am fairly quick to order a CT to further characterize what's going on. MR of course can be helpful as you know but in the sacrum, with all that 'bony stuff goin' on' *said in my best Ernest Hollings imitation* my imaging modality of choice would typically be CT. You'd get no real argument from me though if you preferred MRI.

As I've said before, the MR software/hardware/phased array coils are getting so dadburn good that CT is getting a run for its money, even with bone.

Greg



chiroortho -> Re: low back pain with radiculitis (August 23, 2005 3:13:00 PM)

Oh, and I don't really know what the heck is going on with that sacrum that might lead to radicular symptoms. I'll take a back seat to you guys.



FLAOrthoPT -> Re: low back pain with radiculitis (August 23, 2005 6:05:00 PM)

manipulate L3/4 FRS L solves everything
i think i am going to turn that into a course, 550 bucks for 8 hours, 1 hour to talk about myself, 2 hours of break, and 3 hours to recommend my other courses...such as hitting people hard on the back of the head to reduce elbow pain, i have evidence...



SJBird55 -> Re: low back pain with radiculitis (August 24, 2005 6:51:00 AM)

You know, that sacrum bugs me. By any chance did she recently go through labor and delivery or is the fecal matter shoving on the sacrum?

I don't know about the rest of you, but for me, seeing radiographs first is really an irritant. Is a radiograph really the way that clinical decisions are made? When you look at a radiograph, without seeing the patient, talking to the patient, observing the patient, how do you know what is relevant to the complaint on the radiograph versus just "nice to know" information? From a surgeon's perspective, of course a radiograph is great because the surgeon is looking at where he/she can fix something being the human carpenters that they are.



JLS_PT_OCS -> Re: low back pain with radiculitis (August 24, 2005 7:15:00 AM)

Of course, that's the fun part about these cases, SJ.
Normally the rads would be the last item of the eval, so these little cases force you to focus more carefully on the films since Alex provides so little in the way of information (which I'm sure is intentional).
I think that's the beauty of these cases.

Plus I get to see how wrong I am, and that's always a joy.
:)
J



chiroortho -> Re: low back pain with radiculitis (August 24, 2005 10:31:00 AM)

[QUOTE]Is a radiograph really the way that clinical decisions are made?[/QUOTE]Someone wiser than me once said that you 'treat the patient, not the xray'.

Wish I'd said that.



jma -> Re: low back pain with radiculitis (August 24, 2005 3:59:00 PM)

I would think a radiograph would be an adjunct to help with the diagnosis. However, this would be the case, if it showed something. Suppose everything was normal? Other things in the eval would help determine that but even that isn't absolute either.



Alex Brenner PT MPT OCS -> Re: low back pain with radiculitis (August 25, 2005 12:16:00 AM)

FINDINGS: AP, lateral, and spot lateral lumbosacral views were obtained. There is apparent hypoplasia of the L5 and S1 vertebral bodies on the left side with mild focal curvature of the lumbar spine centered at L2-3. The remaining vertebral bodies are normal in appearance. No significant soft tissue abnormalities are noted.

IMPRESSION: Hypoplasia of the left sides of L5 and S1, likely congenital in nature. This can be better evaluated with CT if clinically indicated.



JLS_PT_OCS -> Re: low back pain with radiculitis (August 25, 2005 1:35:00 AM)

Well, that clears things up...
:)
J



Sebastian Asselbergs -> Re: low back pain with radiculitis (August 25, 2005 2:04:00 AM)

and nothing about the SI area...?



SJBird55 -> Re: low back pain with radiculitis (August 25, 2005 2:07:00 AM)

and the constipation was missed... geesh LOL



Alex Brenner PT MPT OCS -> Re: low back pain with radiculitis (August 25, 2005 2:50:00 AM)

Do you think the radiologist danced around the anomaly pretty good? :)

It is pretty fun to see everyone's interpretation and the fact of the matter is that even the radiologist is unsure what the heck was going on there other than the anomaly.



chiroortho -> Re: low back pain with radiculitis (August 25, 2005 3:35:00 AM)

The sacrum/SIJs are frequently very difficult to evaluate on radiographs due to the weirdness of the joints and the frequency of normal variants. This is one case where I'd personally cut the rad some slack. I can't tell you how many times I've looked at sacral anomalies and scratched my head.

One of the more common anomalies that I see is when the curvature of the lower sacrum/coccyx is almost a 90 degree angle to the upper sacrum. It looks like someone fell on their butt, fx'd the lower sacrum and it healed at a 90* angle. Especially troublesome when it's a young female and I have to ask myself if I need to tell the patient about it in case she gets prego, because one wonders how the baby could get through there without breaking the coccyx (which as you know is VERY common during childbirth).



chiroortho -> Re: low back pain with radiculitis (August 25, 2005 4:24:00 AM)

How's this for a sacral variant?

[IMG]http://www.vh.org/adult/provider/anatomy/AnatomicVariants/SkeletalSystem/Images/22.jpg[/IMG]



Synergy -> Re: low back pain with radiculitis (August 25, 2005 9:14:00 AM)

Yikes Greg! Looks like a Salvador Dali masterpiece. Someone might superimpose that on his "Persistence of Memory" and all would be well.



Yogi -> Re: low back pain with radiculitis (August 25, 2005 12:31:00 PM)

Greg, is the arrow pointing to the variant?



FLAOrthoPT -> Re: low back pain with radiculitis (August 25, 2005 1:46:00 PM)

i think arnlod schwarzenegger killed that thing in predator, I am pretty certain of it, it's forearm counted down, he laughed, arnold ran, and then the thing blew up...yup, definitely dead..



jma -> Re: low back pain with radiculitis (August 25, 2005 2:39:00 PM)

Freaky!



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