Posts: 1057
Joined: March 1, 2004
From: Kentucky
Status: offline
23 year old male was injured when he was partially pinned between a fork lift and the wall 2 years ago while working in a warehouse. He was not seriously injured but has had low back pain for two years; never seen for it in the past. His recent pain has been exacerbated with yard work and he complains of pain radiating from his mid lumbar spine out into the flank on his left side only. What are the findings?
[IMG][/IMG]
[IMG][/IMG]
< Message edited by David Adamczyk -- July 13, 2007 1:44:25 AM >
Posts: 1011
Joined: May 9, 2004
From: West Palm Beach
Status: offline
yeah a LOT of gas here. What are those "pellets" distal to the sacrum? I think there looks to be some abnormality in the sacrum, but I think it may be gas clouding the view. There almost appears to be a small old fracture at the lip of the acetabulum. Disc space looks preserved int he L spine, no real osteophytes or stenosis to speak of, only mild curvuture in frontal plane ubt this can be from behavioral how he is standing.
Overall I'd say his films clear the L-spine and say that his pain in his flank is gastrointestinal in nature, and send him for a endoscopy. Lot's of gas build up there, tell him not to be near any open flames. Ben
Posts: 2639
Joined: August 25, 2000
From: NY
Status: offline
It looks like the lumbar lordosis has straightened out a bit. Not much of a curve. The L1 spinous process looks a little off. Not quite centered. The side view of the T12 body looks like it has a fracture.
Posts: 619
Joined: March 12, 2004
From: Texas
Status: offline
First off, this guy may benefit from 'dropping the kids off at the pool'. I see a fx of the 11th thoracic vertebrae and some sort of opacity in the vertebral body of L4. I see those 'pellets' as well Ben. Perhaps this guy was 'peppered' by a 28-gauge shotgun by Cheney. :)
Posts: 353
Joined: March 29, 2003
From: USA
Status: offline
My eye keeps going to the spinous process of L1(per LLS).
I would guess old L1 SP fracture, based on alignment per LLS, and an apparent increased SP opacity per APLS(to the extent visualized on my very non-diagnostic quality PC monitor).
Posts: 691
Joined: February 19, 2004
Status: offline
[QUOTE]What are those "pellets" distal to the sacrum?[/QUOTE]Yeah my first reaction was phleboliths too because they are SO common in the pelvic basin but take a closer look - it appears that the bladder is distended and since the opacities kind of follow the outline of the bladder one wonders if they're not urinary calculi.
Posts: 353
Joined: March 29, 2003
From: USA
Status: offline
[QUOTE]but take a closer look - it appears that the bladder is distended [/QUOTE]YEAH- It really makes one wonder why preparation for such films dose not include a "pee and poop"!!
Posts: 1011
Joined: May 9, 2004
From: West Palm Beach
Status: offline
interesting side note how is most opitae derivitive narcotics like hrdrocodon, percocet, etc, cause severely impacted bowels. Could be a die note for this guy, was he on pain meds for long time and ignored that he only visits the thrown once a month?
Posts: 17
Joined: February 7, 2006
Status: offline
Were these films standing?
Its very hard for me to see on my lap top monitor but from what I can see
1. Hypolordosis 2. Possible osteophyte on the anterior margin of L5 3.Mild Disc degeneration at L5/S1 4. Facet arthrosis at L4,5, S1 levels 5. Pelvic unleveling on right, possible torsion with sacral apex angulation off to the right 6. Something going on at T12 cant make out due to screen. woudlnt r/o old compression fracture 7. Gas 8. Phleboliths or possible intraductal calculi.
Posts: 1011
Joined: May 9, 2004
From: West Palm Beach
Status: offline
not instigating, really just trying to ascertain how a lot of chiros try to make postural claims such as hyperlordosis and scaral torsions based on static X-Rays. Can't something like this be the manner in which they were positioned, the manner in which they are standing, behavioral changes to avoid painful positions, from leg length discrepencies, etc. how can you label something like loss of lumbar lordosis without posturally screening them in 3 dimensions and checking movement patters of active and passive ranges of motion. Just curious how this can be "seen on X-ray" just would never see "loss of shoulder flexion" on an X-ray film before...I just know that many peopple stand a certain weay to avoid pain, and it is not representative of an anatomical fault, behavioral patterns really shouldn't be assumed in an x'ray reading. If I am wrong, which happens a lot, please correct me, I walwasy wondered about this. Ben
Posts: 17
Joined: February 7, 2006
Status: offline
FLAOrthoPT
I agree with you 100%. However its not limited to DCs. While working in the ER, and attending Osteopathic school we were taught the same things. You document what you see on the film so as if the next Dr in line only had your report (no film to look at) he could see the same thing you are seeing. That however by no means is meant to base a treatment program on 1 static film. It mearly gives a starting point and a another piece of the puzzle.
In regards to my comments above, I was stating what I was seeing at that moment, on that film as if I were to have to document my findings. This could be the pts antalgic posture, no doubt.
I would compare this with previous films and or films I might take at a later date if I were doing corrective care.
I cant speak for other DCs but I would not base a treatment program off of a 1 dimensional plain film xray. I would try a corrilate the physical findings with the xray. Ex. If there is degeneration at the L5S1 level and the pt has a radicular symptoms running down the leg, and other ortho tests indicated a disc problem then I would possibly order an MRI, EMG and base treatment off that.
Its also like looking at a Spondy on a lat film. Is it there... yes grade 2... yes...stable ??? we need to get a history, flex, extension, obliques(pars defect) films, to make a more accurate dx. not just base it off of one film. However if all you have to look at is a lat film then I would record what I seen at that moment a grade 2 spondy.
Good call Ben, I hope that clears up my stance at least.
Printable Version
All Forums >> [RehabEdge Forum] >> Radiology Case Studies >> Old lumbar injury 
Old lumbar injury - 
[/IMG] 
[/IMG]
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