Re: Old lumbar injury

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Alex Brenner PT MPT OCS -> Re: Old lumbar injury (March 4, 2006 1:34:00 AM)
It is not indicated on the films. They were conducted in supine.

Jeep -> Re: Old lumbar injury (March 5, 2006 5:33:00 AM)
Alex- What does "CS"(on the film marker)indicate?

UTDC -> Re: Old lumbar injury (March 5, 2006 9:56:00 AM)
Jeep- It is probably the tech's initials

Alex Brenner PT MPT OCS -> Re: Old lumbar injury (March 5, 2006 10:50:00 PM)
Jeep, UTDC is correct. CS are the technicians initials on the "Mitchell Marker" which is partially obscured because of my poor cropping of the digital picture. Sorry for the confusion.

Jeep -> Re: Old lumbar injury (March 6, 2006 2:54:00 AM)
No problem Alex- This is a "learning" forum. I've not seen that before, and did not know what "CS" meant. I have now learned something new!!. Another question: Is there some reason the "supine vs standing" info was not recorded on the film? I don't want to appear dogmatic- but failure to document this info via markers, would have been given a "fail" grade in DC school. Perhaps this is not important info to others? Perhaps this info was on the films, but not visible on the above submitted films? For discussion purposes only- I only know that which I was instructed in, and things may have changed since my formal x-ray ed.?? Alex-----Your efforts here, are personally appreciated. Thank-you for your time and effort required to make this available.

JLS_PT_OCS -> Re: Old lumbar injury (March 6, 2006 5:32:00 AM)
Jeep- The marker has two small metal ball bearings in it. That portion is obscured per Alex's note above. In a weightbearing film (such as AC series, WB series of joints), the ball bearings are at the bottom of their circular container. In a nonweightbearing film, such as these, the bearings will appear in the middle of the container. Each Xray tech has markers with their initials, a circular area where the bearings are kept, and the letters "R" and "L" on them. They use one of these markers on every film so you know what side is right or left, who shot the film, and if it is weightbearing or not. Hope that helps. J

chiroortho -> Re: Old lumbar injury (March 6, 2006 8:08:00 AM)
I still don't see the L1 spinous fx, although I know Alex posted this with some pathology in mind. I'll call 'em as I see 'em, and although there has to be something funky going on somewhere, I just don't see it. Don't see a compression fx, don't see clinically significant rotation, doggone it I don't see much to speak of at all. I'm looking though. Little hypolordotic lumbar curvature that I'm sure will come back to bite me. Part of the learning experience is to be honest about what we see/don't see. We're all trying to learn what we can, and I won't make fun of anybody even when I think they're missing something obvious. But Alex, feel free to mock me a little, I'd mock me too. Greg 'Out On The Limb' Priest

Jeep -> Re: Old lumbar injury (March 6, 2006 8:54:00 AM)
[QUOTE]The marker has two small metal ball bearings in it. [/QUOTE]That is the marker I was taught to use(without fail), and personally used,(back in the days, when I used to take my own films), on EVERY film I took. Failure to do so was an automatic fail. However, that was in the days of "8 tracks"! I did not see one on the above films. However, in addition to the "right" I am familiar with, and understand, ---"CS" was noted. HMMMM.....I don't remember anything about "CS" in rad/clinic.....back in the "8 track" days" Am I getting "out-digitized"?........or is this some new marking system?.......HMMMMM? CS?...........HMMMM?........"CS?"......Alex said the patient was supine..........HHHMMMM????? CS? Corpse Supine?...........possible????HHHMMMM????? Glad to hear that the old marker I was taught to use, and is used by the imaging center I order films from, are not out of date!! Some things are just fundamentally efficient. Now can we talk about those 8 tracks?!!! How about my VCR and cassettes??????? Oh Nevermind!!!LOL

FLAOrthoPT -> Re: Old lumbar injury (March 6, 2006 9:25:00 AM)
you need a vacation jeep

FLAOrthoPT -> Re: Old lumbar injury (March 6, 2006 9:25:00 AM)
or WAY less coffee

chiroortho -> Re: Old lumbar injury (March 6, 2006 9:30:00 AM)
wow no kidding.

Jeep -> Re: Old lumbar injury (March 6, 2006 11:11:00 AM)
Well I don't see any of you inquiring as to what CS might be- Lighten up----GEESH!!

docb -> Re: Old lumbar injury (March 6, 2006 4:20:00 PM)
JEEP thats because we all knew, (its a conspiracy) he he Greg I couldnt see the Fxr itself due to image quality(I said possibly a fxr)due to 1. the mech of injury 2. the way the upper dorsal really anterior tilts. almost as if its a flexion film, a compression frx would fit at that level. If it did evidence it self on plain film I would follow up with a lower dorsal scan to see if its active. on the A-P the left illia is slightly larger than the right (if obtorators were shown you could really see the rotation) and the sacral apex is cocked over to the right, the vertebra are levorotated with a lumbar convexity to the left. This I deduced was caused by a slight pelvic torsion witht the left superior Illia being anterior. This could also cause the pelvic unleveling (not necessarily a short leg, need a tape measure to determine that) If this is true then the pt might have a left piriformis and quadratus tighter than the right in order to compensate. They might also present with a lateral foot flare on the left (D/T tight piriformis) I would try and coordinate all the "possible" infor off the film with the physical pres. Bryan

UTDC -> Re: Old lumbar injury (March 6, 2006 5:55:00 PM)
[QUOTE] on the A-P the left illia is slightly larger than the right (if obtorators were shown you could really see the rotation) and the sacral apex is cocked over to the right, the vertebra are levorotated with a lumbar convexity to the left. This I deduced was caused by a slight pelvic torsion witht the left superior Illia being anterior. This could also cause the pelvic unleveling (not necessarily a short leg, need a tape measure to determine that) If this is true then the pt might have a left piriformis and quadratus tighter than the right in order to compensate. They might also present with a lateral foot flare on the left (D/T tight piriformis) [/QUOTE]Or.....drumroll please...........it could be that...... The patient was not lying on their back in a perfectly symmetrical fashion

JLS_PT_OCS -> Re: Old lumbar injury (March 7, 2006 1:16:00 AM)
LOL Jeff!!!

chiroortho -> Re: Old lumbar injury (March 7, 2006 1:53:00 AM)
[QUOTE]I couldnt see the Fxr itself due to image quality(I said possibly a fxr)[/QUOTE]Hey Bryan, if there turns out to be a fx there I'm going to blame image quality. That's what I always do. :)

docb -> Re: Old lumbar injury (March 7, 2006 2:52:00 AM)
UTDC that was good, LOL Greg Image quality or the pt must have moved so you have to retake the film (never the Drs bad tech.) off to meetings have a great day all!

Alex Brenner PT MPT OCS -> Re: Old lumbar injury (March 9, 2006 2:03:00 AM)
The purpose of the history of this study was to draw your attention away from the small round densities in the lower pelvis. There is no fracture in this study. Radiology report reads: Lumbar spine [ 3] views: There is no lytic or sclerotic lesion, with mild limitation in evaluation by overlying bowel gas. There is no significant disk space narrowing,with no significant degenerative changes. No fracture or subluxation observed. Small densities, most likely phleboliths, are visualized in lower pelvis. Recommend to correlate these findings clinically. IMPRESSION: Normal lumbar spine [IMG][image]http://img.photobucket.com/albums/v85/brennerak/lumbar3.jpg[/image][/IMG] So the question is, what are phleboliths and should we be concerned? As a PT would you refer back to the physician? Is this worth a call to the referring physician?

FLAOrthoPT -> Re: Old lumbar injury (March 9, 2006 2:21:00 AM)
**** i got one right! it must be tha radiology course my DPT program made me take, just call me Pablo from now on! These little suckers are not emergencies. If your systemic review showed reason to think that there is some bloackage or that they may be kidney stones, which ours does, I would refer back to the doc and let them know these pains may be from the presence of these little suckers and may need a CT scan to further rule out. I do not think it is any medical emergency warranting immediate referral etc, but it should be referred back since this new onset off flank pain may be related. Thanks Alex for the case- Ben

jma -> Re: Old lumbar injury (March 9, 2006 2:41:00 AM)
I believe they are calcifications in the pelvic veins. If they are large enough to cause an obstruction, perhaps they verify this with further followup imaging studies.

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