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Hello and welcome to JA. Dr Saleem here. Will be answering you shortly
Please share the x ray
Would you mind if i have a look?
Alright . These images do not depict anything wrong there. Can you give me bit of history on your symptoms?
Sorry to hear that. Well xray only shows whether there are any bony issues like a fracture. Thats not seen there so there has to be some other cause most likely involving soft tissues such as muscles, tendons, bursa or nerves.
An MRI and Nerve conduction studies are much more helpful in this regard.
You will need regular physiotherapy and TENS sessions alongwith painrelief.
Pain relief can range from simple tylenol to more potent like opioids which ever helps.
Nerve medications like pregabalin and gabapentin would help.
You will need to give your shoulder good rest too.
Alright . The management remains the same for now . I wish you all the best
If you allow so ,i can get help from my radiology colleague. Would it be ok ?
As per the radiologist too, there is no lytic lesion there however in one image he asked me to rule out old healed clavicle fracture but when i sent the next image with a better view of clavicle he ruled that out too.
He thinks its due to poor quality of the image and not a lytic lesion. No clavicle and 12th rib are actually quite a bit away from each other so its definitely not that.
No actually both of us really unable to pick up any lytic lesion there to be honest irrespective of film or image quality
No as its sometimes not clear enough on images and real films might be telling some other story so he might be right there.
Irrespective of the xray findings you need an MRI as your problem is not bony in my view and soft tissue ccindition is only picked by MRI
He is unable to pick any LYTIC LESIONS in the images i shared with him. So according to him there isnt any visible abnormality seen in these images of the x ray you had. Its my own opinion that seeing the real films can be different so your doctor might be in a much better place to comment ,with greater conviction. We comment on what we see ,as radiology is an operator dependent field so findings vary with competence / skill level of each radiologist
Let me discuss these
He maintains ,no lytic lesions.
Only decreased bone mineral density.
Joint space intact
Image 730 was much better
I did mention it to him but he was unable to find out the said abnormality
According to him there is decreased bone mineral density and thats the reason probably why the radiologist has a suspicion.
Well that needs DEXA scan to be definitive about it. The lytic lesions are usually very circumscribed or well demarcated so may be thats what he thinks
Lytic lesions well demarcated or distinguished from rest of the bone so one can immediately pick those. Here it seems more generalized , decreased bone mineral density . Patch of low density might have lead to suspicion of lytic lesion
Yes he is. Asked him twice with both sets of images. Well as i said radiology is afield that depends on skills of the radiologist. So the findings vary with skill level of each specialist.
You are welcome.
I wish you best of luck.
Oh thanks for that . I sure will. Grateful