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Dear Dr Arun, Can you please interpret my x-ray and

Dear Dr Arun, Can you please...
Dear Dr Arun,
Can you please interpret my x-ray and ultrasound (hip) and CT lumbar results?
Firstly, I am a 47 year old female. I am overweight but a non smoker and currently trying to shed the weight. Otherwise very healthy.
However over the last 3 weeks I have been in constant pain on right side hip and lower lumbar area, particularly through the night and after sleep.
X-rays show slight bone spurs in ligament (right hip), otherwise bones fine and no OA. Ultrasound has diagnosed a trochanteric bursitis in the same hip.
CT scan has reported:
L1/2 and L2/3 and L3/4 appear normal.
At L4/5 there is minimal disc bulge without significant thecal impression nor evidence of nerve root impingement.
At L5/S1 there is disc height loss and a minimal degenerative retrolisthesis. There is mild diffuse disc bulge which abuts though does not displace the emerging S1 nerve roots. The canal and foramina otherwise appear normal.
Sacroiliac joint space is well preserved and the articular margins appear normal. There is mild L5/S1 facet joint OA. The facet joints otherwise appear well preserved. No spondylolysis.
Please advise how I can remedy these diagnosis' and alleviate my pain. I should note that I was very busy in house and garden for the 6 weeks prior to this deterioration due to constant visitors. I know weight loss will help but your interpretation, prognosis and advice would be appreciated.
Thank you!
Alison
Canberra ACT, Australia
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Answered in 4 hours by:
6/13/2013
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 36,190
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Verified

Hello Alison,

I am sorry that your question was unanswered for very long. Due to the technical reasons, I could not answer you earlier.

Your x-rays and CT scan show mild degenerative arthritis (bone spurs and minimal disc height loss and retrolisthesis which is slipping of one vertebrae on another and is an age related change, especially occurring in over weight people ). Your symptoms are suggestive of the combination of;

1) Trochanteric bursitis; bursa are fluid filled sac around the joint for the smooth movement of the tendons. Bursitis is inflammation of the bursa and can occur due to over work on a joint.
2) Myofascial pain syndrome
3) Mild degenerative arthritis of back due to over exertion in the garden.

Treatment of Trochanteric bursitis entails;

1) A specific and goal-directed Physical Therapy program; stretching exercises have significant role

2) Transcutaneous electrical nerve stimulation (TENS) can be considered in resistant cases.

3) Iontophoresis and phonophoresis

4) Short wave diathermy

5) Anti-inflammatory analgesics

6) Local analgesic cream / ointment / patch / spray

Myofascial pain syndrome are hyperirritable tender spots in palpable tense bands of skeletal muscle that refer pain. This can be associated with degenerative disc disease and back arthritis. Trigger points may develop after an initial injury to muscle fibers. This injury may be a noticeable traumatic event or repetitive microtrauma to the muscles. The trigger point causes pain and stress in the muscle or muscle fiber. As the stress increases, the muscles become fatigued and more susceptible to activation of additional trigger points. The treatment is following;

1) passive stretching of the affected muscle after application of sprayed vapocoolant.

2) physical therapy; simple muscle stretch, augmented muscle stretch, post-isometric relaxation.

3) deep electrotherapy; iontophoresis, phonophoresis, short wave diathermy, electrical stimulation, high voltage galvanic stimulation, biofeedback.

4) local analgesic patch / ointment / spray

5) anti-inflammatory analgesics; Ibuprofen (Motrin / Advil)

6) ischemic compression therapy; pressure on the points

7) massage

8) steroid shots

9) acupuncture

Following measures also would be helpful;

1) Back care in the activities of daily living, which is an integral component of the treatment of back problems. Back education is one of the most important thing which teaches the basic body mechanics, like correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into and sitting in a car. The training for these routine activity helps in preventing the spasm of the muscles. One needs to consult an occupational therapist or physical therapist which can educate about the proper and improper behaviors when back is painful in case they have to sit, bend forward, lie down, walk, cough, or sneeze. Following more need to be done:

a) Avoid activities which increases the pain.

b) Rest intermittently

c) Avoid bending at 90 degrees

d) Pushing and pulling should be avoided till pain subsides

f) Avoid prolonged sitting and standing

g) Avoid sitting or sleeping on floor

2) Anti-inflammatory analgesics like ibuprofen, other analgesics and muscle relaxants

3) Local analgesic gels or sprays / ointment

4) Hot fomentation

5) Electrotherapy like trans cutaneous electrical nerve stimulation: done by physical therapist. Other thing are ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation, and biofeedback.

6) Good supervised physiotherapy: The exercises consist of abdominal bracing, modified sit-ups, double-knee-to-chest or low back stretches, seat lifts, mountain and sag exercises, knee-to-elbow exercises, hamstring stretches, extension exercises, and extension flexibility exercises. Swimming exercises (pool exercises) are best for back pain. Initial stretching and later strengthening exercises are taught.

7) Lumbosacral corset or support or brace

8) If obese or over weight, reduce weight for long term benefit.

9) Epidural steroid shots

You can start the following exercises;

1) Straight leg raising: Lie on the bed with your back and remain in a relaxed position. Slowly raise one of your legs upward and keep it as straight as possible. Count up to ten, and slowly bring down the leg. Do the same with the other leg. Repeat this exercise ten times.

2) Curl ups; lie on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the bed / couch. Hold for ten seconds, then slowly lower to starting position. As strength builds, aim to complete one sets of ten curls. The exercise should be done twice a day (both the sets).

This is a slide show for the exercises (you can pick up your own set, which suits you);

http://www.mayoclinic.com/health/back-pain/LB00001_D

You can consult following specialists (apart from your GP);

a) Orthopedist

b) Neurologist

c) MD in Physical medicine and rehabilitation

I would be happy to assist you further, if you need any more information.

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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 36,190
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Verified
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Customer reply replied 4 years ago

Thank you for your advice Dr. I have lost 3 kilos and will incorporate your exercises. I will also make am appt to see a good physiotherapy.

You are very welcome.

Best wishes and kindest regards
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