Ideal diagnostics

Overview

Today ours focus is 1] What investigations to do ?

2] How to Write test ? View …

3] How to Read the Reports & Images ?

4] What to do Next ? Follow-up tests needed or not

6] How to approach Neck & Shoulder Pain; Low Backpain & Leg Swellings

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Importance of Diagnosis

Is investigations necessary ?

Only Clinical Evaluation = Management Is it Possible ?

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TEAM EFFORT {Diagnostician & Therapeutician}

CONFIRMATORY DIAGNOSIS { INVESTIGATIONS}

TREATMENTMANAGEMENT

CLINICAL DIAGNOSIS{ PROVISIONAL DIAGNOSIS}

NATUROPATHY

UNANIAYURVEDA

& SIDDHA

HOMEO

ALLOPATHY

FINALFINALDIAGNOSISDIAGNOSIS

Ideal diagnostics

Ideal diagnostics

Importance of Confirmatory Diagnosis

To Choose / Plan Appropriate method of Management

To initiate Early Treatment

To avoid late Complications

For Medico-legal Overcome

For Future Follow-up

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Investigations

Radiology Non-Radiological Lab Tests / Pathology - For all Systems Cardiac – ECG / Treadmill/ ECHO/ ANGIO Neuro- EEG/ ENMG Audiogram - ENT Bone densitometer- BONE Spirometry – Lung Capacity Endoscopy – Any Luminal Structure

Chocolate Cyst Ovary

TB LUNGS

Meningioma

Shoulder Pain

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Ideal diagnostics

What Causes Shoulder Pain?

The shoulder is a ball and socket joint with a large range of movement. Such a mobile joint tends to be more susceptible to injury. Shoulder pain can stem from one or more of the following causes:

1.Strains from overexertion2.Tendonitis from overuse3.Shoulder joint instability4.Dislocation5.Collar or upper arm bone fractures6.Frozen shoulder7. Pinched nerves (also called radiculopathy)

Shoulder Anatomy

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Case Scenario : 1 40 yrs old male with acute onset of Pain Rt

shoulder with restricted movements… Few months

Could it be fracture ? Muscle tear ?? First to R/O Serious one fracture.. Advice … X-Ray Rt Shoulder ..Which view AP View…

X-Ray Shoulder AP View

Look for Bony Parts

Joint Space

Dislocation

Fracture

Normal … What next

ULTRASOUND RT SHOULDER Muscular / Tendinous

Tear { Complete / Partial}

Tendinitis

Joint Effusion

Soft tissue swelling

MRI SCAN SHOULDER Confirmation of earlier

findings

Articular Cartilage / Ligamentous injury

Soft tissue details

Gold Standard for non bony lesions

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X-Ray Shoulder

1. AP VIEW

2. LATERAL VIEW

3. AXILLARY VIEW

X- Ray Shoulder Views

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COMMON SHOULDER PATHOLOGIES:

1. Fracture

2. Dislocations - Anterior / Posterior / inferior

3. Arthritis - Osteoarthritis / others

4. Rotator Cuff Pathologies

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Fracture

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Dislocations

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Gleno-humeral OA

Acromio-Clavicular OA

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Tendinitis in X-Ray

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Ultrasound Shoulder

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Neck PainPrevalence of Neck Pain in the General

Population is about 15 %

Shoulder Problems can masquerade as Cervical Problems & Vice versa

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Ideal diagnostics

What Causes Neck Pain?

•Abnormalities in the bone or joints

•Trauma

•Poor posture

•Degenerative diseases

•Tumors

•Muscle strain

Parts of Cervical Spine

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Ideal diagnostics

Normal Cervical Spine Short Neck Long Neck

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Cervical Spine Typical Vertebrae- Body ; Pedicle; [Vertebral foramen +] Neural arch & Spinous Process

. Atypical Vertebrae- 1. Atlas 2. Axis 3. Long Spinous Process C 7

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Parts of Vertebra Body Endplates Pedicles Lamina Transverse Process Spinous Process

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Spinal Internal Joints Facet Joints Disco-vertebral joints

Types of Arthritis

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DISH { Diffuse idiopathic Skeletal Hyperostosis}

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CERVICAL RIB

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Rheumatoid ArthritisAtlanto-axial Dislocation

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Cervical Spondylosis

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1. Cervical Spondylosis is a general & nonspecific term that encompasses a broad spectrum of afflictions

2. Develops either Spontaneously with age or Secondary as the result of trauma or Pathological Conditions

3. With age loss of water in the disc – loss of absorber effect- secondary changes in facet joints & ligaments – Regeneration { Spur}

4. 3 Phases : [a] Dysfunction – [b] Instability – [c] Stabilization

5. “Soft Disc” herniation- Displaced nucleus Pulposes “Hard Disc” herniation – Posterior marginal osteophytes

Cervical Spondylosis

6. By age 60 – 65 , 95% male & 70% female nonsymptomatic show atleast 1 degenerative sign in the spine

7. Two most common sites C 5-6 disc { C6 root- Biceps} & C 6-7 disc { C7 root- Triceps}

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Cervical Spondylosis

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Cervical to Coccyx

Spinal Curvatures :

Lordosis Scoliosis

Cervical Spondylosis

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Cervical Spondylosis

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Low Back ache

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Low Back Pain 54 yrs old female presented with low

backpain for 1 year duration. Constant, dull ache more focussed on either side of Spine?

Reason? Renal stone ? Gynec ? GB /Pancreas?

Spinal ?

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Backache - ? Spinal

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Ideal diagnostics

Lumbar Spine Pathologies Degenerative Spondylolysis Spondylolisthesis Facet Joint Hypertrophy Ankylosing Spondylitis Spinal Canal Stenosis Osteomyelitis { Koch’s – Pott’s spine } Neoplastic { Multiple Myeloma / Mets}

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Ideal diagnostics

Back Pain Culprit: Chronic Conditions

Several chronic conditions can lead to low back pain.Spinal stenosis is a narrowing of the space around the spinal cord, which can put pressure on the spinal nerves.Spondylitis refers to chronic back pain and stiffness due to severe inflammation of the spinal joints.Fibromyalgia causes widespread muscle aches, including back pain.

Lumbar Spondylosis {DDD}

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Parts of a DISC

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Back Pain Culprit: Herniated DiscThe spine's vertebrae are cushioned by gel-like discs that are prone to wear and tear from aging or injuries. A weakened disc may rupture or bulge, putting pressure on the spinal nerve roots. This is known as a herniated disc and can cause intense pain.

DISC PROLAPSE

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Ideal diagnostics

Lumbar Spondylosis Narrow Disc Space Marginal Osteophytes

Spondylolysis

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Ideal diagnostics

Spondylolysis is a condition in which the there is a defect in a portion of the spine called thepars interarticularis (a small segment of bone joining the facet joints in the back of the spine). With the condition of spondylolisthesis, the pars interarticularis defect can be on one side of the spine only (unilateral) or both sides (bilateral). The most common level it is found is at L5-S1, although spondylolisthesis can occur at L4-5 and rarely at a higher level.

Spondylosis

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Ideal diagnostics

Spondylolisthesis is a condition in which one vertebra slips forward over the one below it.

The most common symptoms are lower back pain and/or leg pain that limits activity level.

Spondylolisthesis

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Spondylolisthesis

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spondyloarthritis

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Ankylosing Spondylitis

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Pedicle metastases

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Spine Neoplasm { MM / Prostate}

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TB Spine { Koch’s / Pott’s spine}

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Ideal diagnostics

osteopenia Senility

Vit.D Deficiency

Hypo-parathyroidism

Hypocalcemia & Hypophosphatasia

HYPEROSTOSIS

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1. HYPERCALCEMIA STATE

2. FLUOROSIS

Backache - ? Non Spinal Urinary Stones ?

Gynec Pathologies ?

Any other ?

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Ideal diagnostics

LEFT RENAL CALCULUS

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LEFT RENAL CALCULUS

Pancreatitis

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Uterine Fibroid

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Ovarian Cyst

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Pelvic X- Ray

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Leg Swelling

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Causes of Leg Swellings

Local Causes:Vascular : Arterial / Venous/ Lymphatic

Musculo-Skeletal

Systemic Causes:Cardiac / Renal / Liver / Anemic / Drug

Induced

Vascular Pathologies

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LOWER LIMB DOPPLER ARTERIAL

Pain is the main Complain

VENOUS

Swelling is the main Complain

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PVD

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Claudication Pain

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Foot Ulcer / Gangrene

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Ideal diagnostics

Peripheral artery disease symptoms include:Painful cramping in your hip, thigh or calf muscles after certain activities, such as walking or climbing stairs (claudication)

Leg numbness or weakness

Coldness in your lower leg or foot, especially when compared with the other side

Sores on your toes, feet or legs that won't healA change in the color of your legs

Hair loss or slower hair growth on your feet and legs

Slower growth of your toenailsShiny skin on your legsNo pulse or a weak pulse in your legs or feetErectile dysfunction in men

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Risk factorsFactors that increase your risk of developing peripheral artery disease include:

SmokingDiabetesObesity (a body mass index over 30)High blood pressureHigh cholesterolIncreasing age, especially after reaching 50 years of ageA family history of peripheral artery disease, heart disease or stroke

High levels of homocysteine, a protein component that helps build and maintain tissuePeople who smoke or have diabetes have the greatest risk of developing peripheral artery disease due to reduced blood flow.

PVD Symptoms Claudication Pain

Ischemic Rest Pain

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Ideal diagnostics

ARTERIAL DOPPLER

Even if you don't have symptoms of peripheral artery disease, you may need to be screened if you are:Over age 70Over age 50 and have a history of diabetes or smokingUnder age 50, but have diabetes and other peripheral artery disease risk factors, such as obesity or high blood pressure

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ComplicationsIf your peripheral artery disease is caused by a buildup of plaques in your blood vessels (atherosclerosis), you're also at risk of developing:Critical limb ischemia. This condition begins as open sores that don't heal, an injury, or an infection of your feet or legs. Critical limb ischemia occurs when such injuries or infections progress and can cause tissue death (gangrene), sometimes requiring amputation of the affected limb.Stroke and heart attack. The atherosclerosis that causes the signs and symptoms of peripheral artery disease isn't limited to your legs. Fat deposits also build up in arteries supplying your heart and brain.

Venous Pathology Deep Vein Thrombosis { DVT }

Varicose Veins

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Varicose Veins

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VARICOSE

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Venous insufficiency is more common in women than in men.

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Symptoms of venous insufficiency include:swelling of the legs or ankles (edema)pain that gets worse when you stand and gets better when you raise your legsleg cramps

aching, throbbing, or a feeling of heaviness in your legsitchy legsweak legsthickening of the skin on your legs or anklesskin that is changing color, especially around the anklesleg ulcersvaricose veinsa feeling of tightness in your calves

Venous Valve

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DVT

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What is Deep Vein Thrombosis?Deep vein thrombosis (DVT) is a serious condition that occurs when a blood clot forms in a vein located deep inside your body. A clot is a clump of blood that has changed from a liquid state to a gelatinous like solid state. Deep vein blood clots typically form in your thigh or lower leg, but they can also develop in other areas of your body. Other names for this condition include thromboembolism, post-thrombotic syndrome, and post-phlebitic syndrome.

DVT

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DVT Causes

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Who Is At Risk?DVT occurs most commonly in people who are over 60 years old. Certain conditions that alter how your blood moves through your veins can raise your risk of developing clots. These include:having an injury that damages your veinsbeing overweight, which puts more pressure on the veins in your legs and pelvishaving a family history of DVThaving a catheter placed in a veintaking birth control pills or undergoing hormone therapysmokingstaying seated for a long time while you’re in a car or on a plane, especially if you already have at least one other risk factor

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Recognizing the Signs and Symptoms of DVTSymptoms of DVT only occur in about half of the people who have this condition. Common symptoms to watch for include:

1. swelling in your foot, ankle, or leg on one sidecramping pain in your affected leg that usually begins in your calf2. pain in your foot and anklean area of skin that feels warmer than the skin on the surrounding areas3. skin over the affected area turning pale or a reddish or bluish color

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Why Is DVT Dangerous?You can develop a pulmonary embolism if a blood clot moves to your lungs and blocks a blood vessel. This can cause serious damage to your lungs and other parts of your body.

You should get immediate medical help if you have signs of a pulmonary embolism such as:dizzinesssweatingchest pain that gets worse with coughing or inhaling deeplyrapid breathingcoughing up bloodrapid heart rate

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Preventing Deep Vein Thrombosis

1.keeping your blood pressure under control, giving up smoking, and losing weight if you’re overweight. 2.Moving your legs around when you’ve been sitting for a while also helps keep your blood flowing. Walking around after being on bed rest can prevent clots from forming. 3.Make sure you take any blood thinners your doctor prescribes if you’re having surgery, as this can lower your chance of developing clots afterwards.

Takehome message… Please Start to Adice “USG SCAN

SHOULDER” for shoulder Pain Digital X- Rays preferred than Conventional X-

Rays Leg Swelling Pain - Arterial doppler Swelling – Venous Doppler Low Backache – advise both X-Ray Spine &

USG Scan abdomen

Significance of RADIOLOGY Ever expanding , Fascinating diagnostic

Modality Proper & Judicious use of Radiology for

arrive at a diagnosis DON’T Lag behind your allopathic

Colleagues Keep update yourself