Basic radiology points in ayurveda
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Transcript of Basic radiology points in ayurveda
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Ideal diagnostics
Overview
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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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Ideal diagnostics
Importance of Diagnosis
Is investigations necessary ?
Only Clinical Evaluation = Management Is it Possible ?
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Ideal diagnostics
TEAM EFFORT {Diagnostician & Therapeutician}
CONFIRMATORY DIAGNOSIS { INVESTIGATIONS}
TREATMENTMANAGEMENT
CLINICAL DIAGNOSIS{ PROVISIONAL DIAGNOSIS}
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NATUROPATHY
UNANIAYURVEDA
& SIDDHA
HOMEO
ALLOPATHY
FINALFINALDIAGNOSISDIAGNOSIS
Ideal diagnostics
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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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Ideal diagnostics
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
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Chocolate Cyst Ovary
TB LUNGS
Meningioma
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Shoulder Pain
Ideal diagnostics
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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)
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Shoulder Anatomy
Ideal diagnostics
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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…
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X-Ray Shoulder AP View
Look for Bony Parts
Joint Space
Dislocation
Fracture
Normal … What next
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ULTRASOUND RT SHOULDER Muscular / Tendinous
Tear { Complete / Partial}
Tendinitis
Joint Effusion
Soft tissue swelling
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MRI SCAN SHOULDER Confirmation of earlier
findings
Articular Cartilage / Ligamentous injury
Soft tissue details
Gold Standard for non bony lesions
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Ideal diagnostics
X-Ray Shoulder
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1. AP VIEW
2. LATERAL VIEW
3. AXILLARY VIEW
X- Ray Shoulder Views
Ideal diagnostics
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COMMON SHOULDER PATHOLOGIES:
1. Fracture
2. Dislocations - Anterior / Posterior / inferior
3. Arthritis - Osteoarthritis / others
4. Rotator Cuff Pathologies
Ideal diagnostics
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Fracture
Ideal diagnostics
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Dislocations
Ideal diagnostics
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Gleno-humeral OA
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Acromio-Clavicular OA
Ideal diagnostics
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Tendinitis in X-Ray
Ideal diagnostics
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Ultrasound Shoulder
Ideal diagnostics
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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
Ideal diagnostics
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Ideal diagnostics
What Causes Neck Pain?
•Abnormalities in the bone or joints
•Trauma
•Poor posture
•Degenerative diseases
•Tumors
•Muscle strain
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Parts of Cervical Spine
Ideal diagnostics
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Ideal diagnostics
Normal Cervical Spine Short Neck Long Neck
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Ideal diagnostics
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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Ideal diagnostics
Parts of Vertebra Body Endplates Pedicles Lamina Transverse Process Spinous Process
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Ideal diagnostics
Spinal Internal Joints Facet Joints Disco-vertebral joints
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Types of Arthritis
Ideal diagnostics
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DISH { Diffuse idiopathic Skeletal Hyperostosis}
Ideal diagnostics
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CERVICAL RIB
Ideal diagnostics
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Rheumatoid ArthritisAtlanto-axial Dislocation
Ideal diagnostics
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Cervical Spondylosis
Ideal diagnostics
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
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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}
Ideal diagnostics
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Cervical Spondylosis
Ideal diagnostics
Cervical to Coccyx
Spinal Curvatures :
Lordosis Scoliosis
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Cervical Spondylosis
Ideal diagnostics
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Cervical Spondylosis
Ideal diagnostics
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Low Back ache
Ideal diagnostics
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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 ?
Ideal diagnostics
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Backache - ? Spinal
Ideal diagnostics
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Ideal diagnostics
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Lumbar Spine Pathologies Degenerative Spondylolysis Spondylolisthesis Facet Joint Hypertrophy Ankylosing Spondylitis Spinal Canal Stenosis Osteomyelitis { Koch’s – Pott’s spine } Neoplastic { Multiple Myeloma / Mets}
Ideal diagnostics
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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.
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Lumbar Spondylosis {DDD}
Ideal diagnostics
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Parts of a DISC
Ideal diagnostics
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Ideal diagnostics
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.
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DISC PROLAPSE
Ideal diagnostics
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Ideal diagnostics
Lumbar Spondylosis Narrow Disc Space Marginal Osteophytes
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Spondylolysis
Ideal diagnostics
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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.
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Spondylosis
Ideal diagnostics
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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.
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Spondylolisthesis
Ideal diagnostics
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Spondylolisthesis
Ideal diagnostics
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spondyloarthritis
Ideal diagnostics
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Ankylosing Spondylitis
Ideal diagnostics
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Pedicle metastases
Ideal diagnostics
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Spine Neoplasm { MM / Prostate}
Ideal diagnostics
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TB Spine { Koch’s / Pott’s spine}
Ideal diagnostics
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Ideal diagnostics
osteopenia Senility
Vit.D Deficiency
Hypo-parathyroidism
Hypocalcemia & Hypophosphatasia
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HYPEROSTOSIS
Ideal diagnostics
1. HYPERCALCEMIA STATE
2. FLUOROSIS
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Backache - ? Non Spinal Urinary Stones ?
Gynec Pathologies ?
Any other ?
Ideal diagnostics
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Ideal diagnostics
LEFT RENAL CALCULUS
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Ideal diagnostics
LEFT RENAL CALCULUS
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Pancreatitis
Ideal diagnostics
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Uterine Fibroid
Ideal diagnostics
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Ovarian Cyst
Ideal diagnostics
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Pelvic X- Ray
Ideal diagnostics
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Leg Swelling
Ideal diagnostics
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Causes of Leg Swellings
Local Causes:Vascular : Arterial / Venous/ Lymphatic
Musculo-Skeletal
Systemic Causes:Cardiac / Renal / Liver / Anemic / Drug
Induced
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Vascular Pathologies
Ideal diagnostics
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LOWER LIMB DOPPLER ARTERIAL
Pain is the main Complain
VENOUS
Swelling is the main Complain
Ideal diagnostics
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PVD
Ideal diagnostics
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Claudication Pain
Ideal diagnostics
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Foot Ulcer / Gangrene
Ideal diagnostics
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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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Ideal diagnostics
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.
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PVD Symptoms Claudication Pain
Ischemic Rest Pain
Ideal diagnostics
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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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Ideal diagnostics
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.
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Venous Pathology Deep Vein Thrombosis { DVT }
Varicose Veins
Ideal diagnostics
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Varicose Veins
Ideal diagnostics
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VARICOSE
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Venous insufficiency is more common in women than in men.
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Ideal diagnostics
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
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Venous Valve
Ideal diagnostics
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DVT
Ideal diagnostics
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.
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DVT
Ideal diagnostics
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DVT Causes
Ideal diagnostics
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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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Ideal diagnostics
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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Ideal diagnostics
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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Ideal diagnostics
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.
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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
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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