Дискусије : Здравље

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Za neurologa! (zecic)
grinder
(drvosjeca)
03. март 2012. у 19.08
povrijedio sam se na poslu dizajuci neki kamen, ima vise od mjesec dana, teško se krecem, niti mogu da sjedim, stojim, hodam, lezim. lijekove sto sam podobijao, ne podnosim ( ni moj zeludac-dobio sam i lijekova za zeludac, ne odgovaraju mi ni oni). zakazali su mi „inekciju” krajem marta, a 3/21 idem kod neursurgen-a. niko ništa ne zna, svi peru ruke, ko nije otprilike strasno, al niko još tačno ne odgovara šta mi je i kakve su mi sanse za oporavak. radili su x-rays, mri , EMG,ako neurolog može da mi protumaci ove nalaze. (znam i ja da googlam, ne treba mi copy/past sa nekog sajta, bez uvrede pojedincima)
trenutno idem samo kod kiroprakticara/slaba vajda, ionako ne može ništa da radi sa mnom.
evo mojih nalaza:

MRI:

HISTORY: Back pain, Pain radiates into the buttock regions, evalllllte. Strain/sprain, radiculitis, segmental dysfunction, laxity of ligaments.

COMPARISON: None.

TECHNIQUE: Multiplanar, multipulse sequences of the lumbar spine were performed without contrast.
FINDINGS: Straightening of the normal lumbar lordotic cUrve is noted. A inferior right L4 endplate Schmorl's node is present. The vertebral body alignment is maintained, Mild L4-Ls disc space narrowing is present. Loss of the normal T2. hyperintensity within the L4-Ls intervertebral discs are consistent with disc desiccation, The vertebral body heights are maintained. No abnormal marrow signal is noted, The conus medullaris is normal in signal and morphology and terminates at T12-Ll.

The below intervertebral disc space levels are based bases on the presumed 5 nonrib bearing lumbar vertebrae anatomy, without transitional anatomy,

T12-Ll-L3-L4; No disc herniation or stenosis is present.

L4-LS: A shallow midline disc herniation is present. A diffuse broad-based disc bulge causes effacement of the anterior thecal sac. No central canal stenosis is noted.

L5-S1: No disc herniation or stenosis is present.

IMPRESSION:

1. T12-L1-L3-L4, L5-S1: No disc herniation or stenosis_

2.L4-L5: Shallow midline disc herniation , diffuse broad-based disc bulge, no central canal stenosis.

3.EMG studies may be useful for further evaluation of underlyig lumbar radiculopathy and/or neuromuscular dysfunction if clinically indicated,

X-RAY:
CLINICAL INDICATIONS: Patient hurt his back lifting a heavy parts at work. Pain radiating down his right leg.

FINDINGS: Three views of the lumbosacral spine reveals no evidence 0f acute fracture or destructive bony lesion. The joint spaces are maintained. There are minimal degenerative changes seen along the anterior endplates at the L4-5 level. The neural canal is unremarkable. The facet joints are normal. The bone density is normal.

IMPRESSION:

MILD DEGENERATIVE CHANGES ALONG THE ANTERIOR ENDPLATES AT L4-5. GIVEN THE CLINICAL SYMPTOMS AND HISTORY AN MRI IS RECOMMENDED FOR FURTHER EVALUATION OF POSSIBLE DISC HERNIATION AND/OR NERVE ROOT IMPINGEMENT.

EMG:

ELECTRODIAGNOSTIC FINDINGS:

1. Normal distal motor conduction latencies and amplitudes of the Tibial and Peroneal nerves.

2. Normal F-responses of the Tibial and Peroneal Nerves bilaterally.

3. Normai distal sensory peak latencies of the right and left Peroneal and Sural nerves.

4. Normal right and left Tibial nerve H-reflexes.

5.··-Normal needle EMG examination of the right and left lower limb and paraspinal muscles.

CONCLUSIONS: The electrophysiological data obtained coupled with his clinical signs and symptoms, physical examination findings, and advanced imaging findings indicate that he exhibits no electrophysiologic evidence of an active or chronic radiculopathy at this time. The monopolar needle EMG examination failed to yield any evidence of spontaneous potentials or chronic neuropathic motor units in the various lower limb muscles or in the lumbar paraspinal muscles sampled. Normal motor nerve conduction studies of the tibial and peroneal nerves rule out the probability of a focal mononeuropathy, such as an entrapment syndrome of these nerves. Additionally, there were normal peroneal and sural sensory studies obtained bilaterally.

It is likely that the proximal lower extremity symptomatology that Mr.is experiencing is secondary to a referred pain pattern from the lumbar facet joints, paraspinal muscles and perhaps a discogenic pain syndrome. This scenario is highly likely as he was injured in a work-related incident on January 25,2012 and sustained injuries to the lumbar spine including apparent disc injury at the L4-L5 level. Although frank nerve root effacement was not visualized on MRI and no evidence of radiculopathy was evident on needle EMG, it is likely that he is experiencing sclerotogenous pain along with discogenic pain from the injured disc.

As a result of this diagnosis of Discogenic Referred Pain Syndrome, this patient has been referred to their orthopedic or neurological specialist with a copy of these results for further medical evaluation. Due to the inflammatory nature of this type of condition, recommendations inclUding the addition of natural fish oil, EPNDHA, as well as the use of a glucosamine/chondroitin supplement such as Metagenics-brand Chondrocare have been made to promote healing of the injured soft tissues particularly collagen and cartilage fibers. Appropriate changes in this patient's in-office treatment plan have been made to ensure that chiropractic procedures performed are the safest and most effective in the treatment of this injury, including the use of Flexion Distraction Techniques. Also, ongoing in-office chiropractic care will continue to focus on the restoration of spinal alignment as well as the resolution of hypertonic musculature and myofascial trigger points. This patient has also received instruction as appropriate in spinal and core strengthening exercises to promote spinal stabilization and prevention of re-injury. These recommendations are medically necessary to support healing of this injury, to maintain the patient's present level of function, to promote progressive functional gains, and to prevent further regression of this patient's condition.

IMPRESSION:

1. Discogenic pain syndrome/musculoligamentous pain syndrome.

2. No electrophysiological evidence of an active or chronic lumbar radiculopathy, peripheral neuropathy, or lumbar plexopathy.

3. Patient's treatment plan will be changed as a result of this testing as stated above.
fiji40
(hgfg)
04. март 2012. у 16.20
druže,uzmi tabletu za stomak poput zantaca uz lijekove i ja sam imao iste probleme pa mi je dr sugerisao to i odlično podnosim lijekove.Želim ti da sto prije ozdravis
zecic-zecic
05. март 2012. у 13.08
Sa malim zakasnjenjem.

problem je prolično jednostavan za objašnjenje. Jedan disc je „izleteo”, pomerio se sa normalnog mesta pa pritiska nerv i izaziva bol. U početku je najgore dok postoji „upala, reakcija” okolnog tkiva a posle se disc smanji pa je lakse. Lekovi se preporucuju samo ako je bas neizdrzljivo jer maskiranjem bola izgubite njegovu zatitinu ulogu pa cinite i pokrete koji vode daljem ostecenju. Čim budete u stanju, sto pre pocnite sa fizikalnom terapijom. Vezbe su daleko najvazniji deo terpije pa kad ih naucite radite ih uporno i kod kuce. Izgleda jednostavan savet ali je neverovatno učinkovit. Bez mnogo mudrovanja, samo redovne vezbe i bicete u redu.

neurolog
sc_johnny2012
05. март 2012. у 14.16
Lezanje, lezanje i samo lezanje dok bol ne prođe. Nikakvi napori, nikakvo savijanje, čak ne ni sedenje niti ustajanje iz kreveta sem za blagu setnju ili kad se bas mora. Ako treba kupite uzdignuto sediste za WC da vam bude lakse da sednete. Sedenje je za vas sada jako opasno, kao i podizanje bilo čega. Hodanje bi bilo odlično, ako mozete, i samo u jako udobnim i mekanim cipelama. Bilo bi dobro kada biste mogli da hodate svaki dan, sve dok vas ne zaboli, da vam ne bi misici ledja atrofirali, što se desi posle samo dve nedelje lezanja bez hodanja. Takođe pijte puno vode i C vitamina. Ceo zivot prilagodite oporavku, i sve će biti u redu, mada ne odmah. Kada vas prođe bol, za par nedelja, makar kada postane bolje, onda krenite sa fizioterapijom jer to vam je jedina nada - vezbe, možda u bazenu ako toga ima tu gde živite. Akupunktura nije losa ako lekar zna šta radi.

Za sada, ako mozete, pijte Iboprufen, uz hranu, nadjite onaj koji je plave boje, kao tecnost u piluli, trebalo bi da ne smeta stomaku.
Inače nemate nikakvu povredu nerva, sto je dobra stvar, čak nemate ni smanjen prostor između L4 i L5 prsljenova, sto je takođe dobra stvar. To će se tako odrzati ako vam misici ostanu jaki. Nadam se da neuroloski testovi nisu boleli suvise jer su nervi već iziritirani...

I kada krene oporavak, kada vam bude bilo bolje, zapamtite da se nikada više ne savijate da podignete nešto teško. Dizanje bilo čega pa čak i samo nečega sitnog u radnji (recimo gallon of milk) od sada pa na dalje se radi kolenima, a ne ledjima. Dobar fiziterapeut bi trebalo da vam sve to objasni kada budete krenuli na vezbe.
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