RehabEdge Physical Therapy Forum

Forums  Register  Login  Forgot Login?
  My Profile 
My Subscription
  My Forums 
Search
  FAQ  Log Out
Follow @RehabEdge

Re: Mountain Biking

 
Logged in as: Guest
Users viewing this topic: none
  Printable Version
All Forums >> [RehabEdge Forum] >> Radiology Case Studies >> Re: Mountain Biking Page: <<   < prev  1 [2] 3   next >   >>
Login
Message << Older Topic   Newer Topic >>
Re: Mountain Biking - July 11, 2005 10:26:00 AM   
chiroortho

 

Posts: 691
Joined: February 19, 2004
Status: offline
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'.

_____________________________

Greg Priest, DC, DABCO

(in reply to Alex Brenner PT MPT OCS)
Post #: 21
Re: Mountain Biking - July 12, 2005 7:55:00 AM   
Jeep

 

Posts: 353
Joined: March 29, 2003
From: USA
Status: offline
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.).

(in reply to Alex Brenner PT MPT OCS)
Post #: 22
Re: Mountain Biking - July 12, 2005 11:21:00 AM   
JLS_PT_OCS

 

Posts: 1684
Joined: January 31, 2005
From: USA
Status: offline
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

_____________________________

Jason Silvernail DPT
Board-Certified in Orthopedic Physical Therapy
Certified Strength and Conditioning Specialist
www.silvernailstudios.com
jasonsilvernail@gmail.com

(in reply to Alex Brenner PT MPT OCS)
Post #: 23
Re: Mountain Biking - July 12, 2005 5:24:00 PM   
chiroortho

 

Posts: 691
Joined: February 19, 2004
Status: offline
Sorry, don't quite follow you here. I listed some findings, not a diagnosis, unless 'no fractures or dislocations' is a diagnosis.

_____________________________

Greg Priest, DC, DABCO

(in reply to Alex Brenner PT MPT OCS)
Post #: 24
Re: Mountain Biking - July 12, 2005 7:25:00 PM   
Jeep

 

Posts: 353
Joined: March 29, 2003
From: USA
Status: offline
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!

(in reply to Alex Brenner PT MPT OCS)
Post #: 25
Re: Mountain Biking - July 12, 2005 10:11:00 PM   
jma

 

Posts: 2639
Joined: August 25, 2000
From: NY
Status: offline
Hmmm, what are the findings then Alex? Should be interesting.

(in reply to Alex Brenner PT MPT OCS)
Post #: 26
Re: Mountain Biking - July 19, 2005 7:01:00 AM   
Alex Brenner PT MPT OCS

 

Posts: 1057
Joined: March 1, 2004
From: Kentucky
Status: offline
Sorry for being so slow with the findings. I was double checking with one of our radiologists up north. The following is the radiology report.

PROCEDURE: Three views of right shoulder.

FINDINGS: Lucencies are seen in the glenoid, either subchondral cysts or calcific tendonitis. There is a Hill-Sachs lesion of the right humeral head with a bone fragment adjacent to it. No osteophytes are seen to support the presence of osteoarthritis. The right acromion is laterally down-sloping, a finding that may contribute to impingement. There is no definite arthropathy of the acromioclavicular joints. No fracture or malalignment is seen.

The yellow arrow represents the small Hill Sachs lesion.


The yellow circle is Lance Armstrong's braclet. Just joking, it is what is referred to above as the adjacent bone chip from the Hill Sach's lesion.

< Message edited by Randy J Moore -- July 22, 2007 11:32:13 PM >


_____________________________

Alex Brenner, PT, MPT, OCS

(in reply to Alex Brenner PT MPT OCS)
Post #: 27
Re: Mountain Biking - July 19, 2005 8:53:00 AM   
chiroortho

 

Posts: 691
Joined: February 19, 2004
Status: offline
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

_____________________________

Greg Priest, DC, DABCO

(in reply to Alex Brenner PT MPT OCS)
Post #: 28
Re: Mountain Biking - July 19, 2005 10:52:00 AM   
Alex Brenner PT MPT OCS

 

Posts: 1057
Joined: March 1, 2004
From: Kentucky
Status: offline
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.

_____________________________

Alex Brenner, PT, MPT, OCS

(in reply to Alex Brenner PT MPT OCS)
Post #: 29
Re: Mountain Biking - July 19, 2005 1:09:00 PM   
Synergy

 

Posts: 619
Joined: March 12, 2004
From: Texas
Status: offline
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. :)

_____________________________

Chris Adams, PT, MPT

(in reply to Alex Brenner PT MPT OCS)
Post #: 30
Re: Mountain Biking - July 20, 2005 12:59:00 AM   
chiroortho

 

Posts: 691
Joined: February 19, 2004
Status: offline
Chris,

Yes.

_____________________________

Greg Priest, DC, DABCO

(in reply to Alex Brenner PT MPT OCS)
Post #: 31
Re: Mountain Biking - July 20, 2005 9:30:00 AM   
Synergy

 

Posts: 619
Joined: March 12, 2004
From: Texas
Status: offline
Greg,

Thanks. :)

_____________________________

Chris Adams, PT, MPT

(in reply to Alex Brenner PT MPT OCS)
Post #: 32
Re: Mountain Biking - July 22, 2005 11:45:00 AM   
SJBird55

 

Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
Hey, Alex.. how come that clavicle looks like it's in the wrong position? What's the scoop on that?

(in reply to Alex Brenner PT MPT OCS)
Post #: 33
Re: Mountain Biking - July 25, 2005 11:40:00 PM   
Dr.Wagner


Posts: 1242
Joined: January 25, 2003
From: Indianapolis
Status: offline
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.

_____________________________

Dr. Wagner DO
Moderator of Medical Complexity Forum

(in reply to Alex Brenner PT MPT OCS)
Post #: 34
Re: Mountain Biking - July 26, 2005 8:20:00 PM   
SJBird55

 

Posts: 3332
Joined: May 11, 2004
From: Michigan
Status: offline
Ah... why would anyone want the pic distorted? Geesh that is irritating (at least to me).

(in reply to Alex Brenner PT MPT OCS)
Post #: 35
Re: Mountain Biking - July 27, 2005 8:44:00 AM   
JLS_PT_OCS

 

Posts: 1684
Joined: January 31, 2005
From: USA
Status: offline
Rad tech took a poor film. The QI process at the radiology dept didn't catch it.
J

_____________________________

Jason Silvernail DPT
Board-Certified in Orthopedic Physical Therapy
Certified Strength and Conditioning Specialist
www.silvernailstudios.com
jasonsilvernail@gmail.com

(in reply to Alex Brenner PT MPT OCS)
Post #: 36
Re: Mountain Biking - July 27, 2005 11:12:00 AM   
Alex Brenner PT MPT OCS

 

Posts: 1057
Joined: March 1, 2004
From: Kentucky
Status: offline
Hey J, were the radiology techs like "derr"? :)

_____________________________

Alex Brenner, PT, MPT, OCS

(in reply to Alex Brenner PT MPT OCS)
Post #: 37
Re: Mountain Biking - July 27, 2005 11:58:00 AM   
JLS_PT_OCS

 

Posts: 1684
Joined: January 31, 2005
From: USA
Status: offline
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
Board-Certified in Orthopedic Physical Therapy
Certified Strength and Conditioning Specialist
www.silvernailstudios.com
jasonsilvernail@gmail.com

(in reply to Alex Brenner PT MPT OCS)
Post #: 38
Re: Mountain Biking - July 27, 2005 12:21:00 PM   
Shill

 

Posts: 1377
Joined: February 14, 2003
From: Madison WI USA
Status: offline
Did I miss what "derr" means somewhere?

_____________________________

Steve Hill PT

(in reply to Alex Brenner PT MPT OCS)
Post #: 39
Re: Mountain Biking - July 27, 2005 1:35:00 PM   
karmzack

 

Posts: 181
Joined: March 21, 2005
From: Hawaii
Status: offline
"derr" - see the DVT thread in the ortho section

_____________________________

Zack Solomon MPT, OCS, CSCS

(in reply to Alex Brenner PT MPT OCS)
Post #: 40
Page:   <<   < prev  1 [2] 3   next >   >>
All Forums >> [RehabEdge Forum] >> Radiology Case Studies >> Re: Mountain Biking Page: <<   < prev  1 [2] 3   next >   >>
Jump to:





New Messages No New Messages
Hot Topic w/ New Messages Hot Topic w/o New Messages
Locked w/ New Messages Locked w/o New Messages
 Post New Thread
 Reply to Message
 Post New Poll
 Submit Vote
 Delete My Own Post
 Delete My Own Thread
 Rate Posts



Google Custom Search
Forum Software © ASPPlayground.NET Advanced Edition 2.5.5 Unicode

0.141