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Line 18: |
Line 18: |
| *Canโt comfortably hold 7 month infant | | *Canโt comfortably hold 7 month infant |
| *Poor sleep โ best on side pillow between knees | | *Poor sleep โ best on side pillow between knees |
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| Examination=
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| *An engaging man not obviously in pain
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| *Could reach middle of shins; L. ext. hurt
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| *Bilateral slump test and SLR (To 50* ) caused pain in the central LS area
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| *Intact reflexes
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| *Blunting of pin prick dorsum right foot
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| *Antalgic weakness
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| |-|
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| Imaging=
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| [[File:Interspinous_Oedema_MRI.jpg]]
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|
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| {{Collapsible textbox
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| |title=MRI Lumbar Spine Report
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| |text=
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| *Lumbar MRI 8 weeks post injury on 18.12.2019
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| ** No evidence of nerve root compression or displacement.
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| ** Minimal annular bulge at L4-5.
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| ** No visible annular fissure.
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| ** Mild interspinous oedema at L4-L5.
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| *Requested F/U MRI 19/12/2019: coronal views ofย lumbar interspinous spaces
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| **Coronal and repeat sagittal views confirm interspinous ligament oedema at L4/5 rather than vessels.
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| {{Practice point|text=Learning point:
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| Ask for a T2 fat suppressed Dixon coronal. Corroborate the coronal ISO in the sagittal plane. Have the sequence start posterior to the spines. A STIR will suffice but less resolution }}
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| }}
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| |-|
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| Management=
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| [[File:Interspinous_Oedema_Fluoroscopic_Injection.jpg]]
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|
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| 7th January 2020 (11 weeks post injury)
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| *9 cm 22-gauge spinal needle advanced into the interspinous space using AP and lateral projections.
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| *1 mL Omnipaque 300 infiltrated into the interspinous space to ensure position.
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| *A mixture of 40 mg Kenacort A and 0.5 mL 0.75% Ropivacaine was infiltrated into the L4/5 interspinous space.
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| *No immediate complications.
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| |-|
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| Follow up=
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| '''24th January 2020ย (14 weeks post injury)'''
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|
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| <gallery mode=packed heights=150px>
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| File:ISO_pain_case_0.png|VAS 4-5 to 7/10
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| File:ISO pain case 0 post injection.png|VAS 1-2/10
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| </gallery>
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| I reviewed P today and explained to him that he used his โget out of jail cardโ with the successful interspinous focal steroid injection between L4 and L5 has treated the periostitis and ligament injury.
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| Within days he had an improvement in the local pain and the impulse pain and was moving freely.
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| He lost his impulse pain and began to move freely.
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| Examination
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| I saw him jog across the road today as he was running late, so I think he is moving freely.
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| His general movements are fine without any obvious issues.
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| He was able to bend forward and effortlessly reach just to his ankles; extension was normal.
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| His straight leg raise was increased on the right to approximately 80 degrees limited by hamstring tightness, and on the left to 70 degrees limited by hamstring tightness.
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| There was no tenderness to palpation in his buttocks or spinous and interspinous processes today.
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| |-|
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| Related Articles=
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| *[[Interspinous Oedema]]
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| </tabber> | | </tabber> |
| [[Category:Case Histories]] | | [[Category:Case Histories]] |