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Subchondral degenerative cysts: Subchondral Bone Cyst: Symptoms, Causes, and Treatments

Subchondral Bone Cyst: Symptoms, Causes, and Treatments

What Is a Subchondral Bone Cyst?

It’s a fluid-filled sac that forms in one or both of the bones that make up a joint. They’re especially common at the knee or hip. The cysts show up just under the tough spongy tissue (called cartilage) that covers the bone near the joint.

Your doctor might call them:

  • Osteoarthritic cysts
  • Pseudocysts
  • Geodes
  • Egger cysts (in the hip socket).

Causes of Subchondral Bone Cysts

Osteoarthritis (OA) is the most common. It breaks down the cartilage. OA can happen from simple wear and tear over time, or because of a sudden injury to a joint.

Either way, the normal, smooth, gliding of one bone against another in your joints starts to cause more friction. That leads to the cyst.

In cases of late rheumatoid arthritis, where your immune system attacks and inflames your joints, subchondral bone cysts can also form.

In other cases, a joint injury might lead to a cyst without OA.

Symptoms of Subchondral Bone Cysts

The cysts themselves don’t seem to cause symptoms. But in rare cases, they can push on soft tissue in the area. That can cause pain.

Continued

More often, if you have pain, it’s due to the osteoarthritis that causes the cysts. The pain tends to come and go at first. But it gets worse over time, or if you’re very active. It might be especially serious when you wake up. Eventually, the pain can become constant.

As OA gets worse, stiffness and swelling can make it harder for your joints to work the way they should. You might also feel weaker over time — so much so that it gets harder to do simple things, like open a jar or bend down.

With OA of the hip or knee — where cysts are more common — you might have pain in your:

  • Groin
  • Thigh
  • Buttocks
  • Area behind the knee

You might also feel a grinding or scraping sound when you move your joint.

Over time, the cyst itself can start to damage your joint. That can keep you from being able to make some movements.

Diagnosis of Subchondral Bone Cysts

Your doctor will examine you and ask about any pain or stiffness you’re having.

If you have pain, swelling, or stiffness that could be from OA or a joint injury, your doctor will order X-rays or other imaging tests. Any cysts you have will show up on these tests.

Treatment

Subchondral cysts may not cause any symptoms. But sometimes, they continue to grow. That may start to change the way your joint works. If this happens, your doctor might suggest using a needle to drain the cyst.

Other than that, your doctor will try to treat the cause of your cyst — in most cases, OA or a joint injury.

Though there is no cure for OA, your doctor can help you manage your symptoms with:

In rare cases, you might have surgery to replace a joint.

Talk with your doctor about which treatment might be best for you.

Subchondral bone cyst: Causes, treatment, and symptoms

Subchondral bone cysts are sacs of fluid that form inside a person’s joints. The cysts occur in the subchondral bone, the layer of bone just under the cartilage.

The subchondral bone acts as a shock absorber in weight-bearing joints, such as the knees, hips, and shoulders. The liquid inside subchondral bone cysts (SBCs) is hyaluronic acid, a component found in synovial fluid, which is the thick substance that lubricates joints, allowing the bones to slide past one another without friction.

Risk factors for SBCs include obesity and smoking, but the precise cause is unknown. Symptoms include joint pain and discomfort. Lifestyle changes help symptom relief and may prevent the formation of other SBCs.

Fast facts on SBCs:

  • Initially discovered in the 1940s, SBCs are a sign of osteoarthritis (OA).
  • The exact cause of SBCs is not known.
  • Engaging in high-impact activities can contribute to injury and damage to the joint and cartilage over time, possibly leading to SBCs.
  • SBCs are diagnosed using imaging tests, such as X-rays.

Some experts believe that SBCs are a precursor to osteoarthritis (OA), which itself is a painful condition affecting more than 30 million adults in the United States.

OA causes the cartilage and bones within a joint to gradually break down. SBCs are considered one of the four cardinal or key radiological findings for OA.

However, in one large study of 806 people with OA in the knee, SBCs were found in only 30.6 percent of them. Other conditions besides OA, such as rheumatoid arthritis, also cause cysts to form on the bone joints.

Though the cause is unknown, it is thought SBCs are the result of repeated stress to the bone. This stress is caused by increased pressure from quicker blood flow to the subchondral bone, something that is seen in people with OA.

Certain characteristics and behaviors can increase the risk of developing an SBC. These include:

  • Sex – women may have a higher risk than men of SBC formation, according to some research.
  • Heredity – as certain forms of OA may be hereditary, people with a family member with the condition are more likely to develop OA and SBCs.
  • Joint alignment and shape – abnormal joint shape or alignment can increase friction, leading to greater damage and a higher risk of cyst formation.
  • Obesity – carrying excess weight puts additional pressure on the joints of the body, increasing the risk of joint problems.
  • Smoking – tobacco contains chemicals that contribute to cartilage damage. Some research has shown that male smokers with OA experience greater cartilage loss.
  • Activity and injury – joint injuries increase the risk of joint problems later, including the development of SBCs.

It is recommended that SBCs are not treated directly. Due to the risk of infection, these cysts should not be removed. However, they can regress on their own.

As a result, treatment typically involves making lifestyle changes and providing symptom relief. Some people may benefit from replacing the joint if problems are ongoing or progressive.

Treatments for SBCs include the following:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

These over-the-counter painkillers, such as ibuprofen and aspirin, may reduce symptoms of SBCs. It is always advisable to check with a doctor before taking NSAIDs. Long-term use should be avoided.

Low-impact activities

It may be recommended to choose low-impact activities such as swimming, aqua aerobics, and cycling. These put less pressure on the knees and hips joints than high-impact activities, such as running and jumping, which can exacerbate the symptoms of OS and SBCs and lead to further joint damage over time.

Weight management

Maintaining a healthy weight reduces excess stress on the joints and may reduce the rate of cartilage loss.

Quit smoking

As this is a risk factor for the development of osteoarthritis, quitting smoking and avoiding secondhand smoke may reduce the symptoms of SBCs and OA.

Ultrasound therapy

At least one study suggests that delivering localized ultrasonic therapy to cartilage and subchondral bone may help treat OA. However, much more research is needed in this area.

Physical therapy

According to the American Academy of Family Physicians, mild degenerative joint disease, of which SBCs may be a feature, can be treated with physical therapy.

If present, symptoms of SBCs can include:

  • discomfort
  • pain
  • lack of flexibility in the joint
  • swelling or bulging around the joint

There are only a few symptoms associated with SBCs, as they are typically considered to be a symptom of OA, particularly progressive OA.

SBCs are considered a symptom of OA or other joint conditions. They may resolve on their own or persist long-term. SBCs may cause pain and contribute to disease progression.

The best way to treat these cysts is to manage the symptoms of OA and other joint conditions.

Subchondral bone cyst: Causes, treatment, and symptoms

Subchondral bone cysts are sacs of fluid that form inside a person’s joints. The cysts occur in the subchondral bone, the layer of bone just under the cartilage.

The subchondral bone acts as a shock absorber in weight-bearing joints, such as the knees, hips, and shoulders. The liquid inside subchondral bone cysts (SBCs) is hyaluronic acid, a component found in synovial fluid, which is the thick substance that lubricates joints, allowing the bones to slide past one another without friction.

Risk factors for SBCs include obesity and smoking, but the precise cause is unknown. Symptoms include joint pain and discomfort. Lifestyle changes help symptom relief and may prevent the formation of other SBCs.

Fast facts on SBCs:

  • Initially discovered in the 1940s, SBCs are a sign of osteoarthritis (OA).
  • The exact cause of SBCs is not known.
  • Engaging in high-impact activities can contribute to injury and damage to the joint and cartilage over time, possibly leading to SBCs.
  • SBCs are diagnosed using imaging tests, such as X-rays.

Some experts believe that SBCs are a precursor to osteoarthritis (OA), which itself is a painful condition affecting more than 30 million adults in the United States.

OA causes the cartilage and bones within a joint to gradually break down. SBCs are considered one of the four cardinal or key radiological findings for OA.

However, in one large study of 806 people with OA in the knee, SBCs were found in only 30.6 percent of them. Other conditions besides OA, such as rheumatoid arthritis, also cause cysts to form on the bone joints.

Though the cause is unknown, it is thought SBCs are the result of repeated stress to the bone. This stress is caused by increased pressure from quicker blood flow to the subchondral bone, something that is seen in people with OA.

Certain characteristics and behaviors can increase the risk of developing an SBC. These include:

  • Sex – women may have a higher risk than men of SBC formation, according to some research.
  • Heredity – as certain forms of OA may be hereditary, people with a family member with the condition are more likely to develop OA and SBCs.
  • Joint alignment and shape – abnormal joint shape or alignment can increase friction, leading to greater damage and a higher risk of cyst formation.
  • Obesity – carrying excess weight puts additional pressure on the joints of the body, increasing the risk of joint problems.
  • Smoking – tobacco contains chemicals that contribute to cartilage damage. Some research has shown that male smokers with OA experience greater cartilage loss.
  • Activity and injury – joint injuries increase the risk of joint problems later, including the development of SBCs.

It is recommended that SBCs are not treated directly. Due to the risk of infection, these cysts should not be removed. However, they can regress on their own.

As a result, treatment typically involves making lifestyle changes and providing symptom relief. Some people may benefit from replacing the joint if problems are ongoing or progressive.

Treatments for SBCs include the following:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

These over-the-counter painkillers, such as ibuprofen and aspirin, may reduce symptoms of SBCs. It is always advisable to check with a doctor before taking NSAIDs. Long-term use should be avoided.

Low-impact activities

It may be recommended to choose low-impact activities such as swimming, aqua aerobics, and cycling. These put less pressure on the knees and hips joints than high-impact activities, such as running and jumping, which can exacerbate the symptoms of OS and SBCs and lead to further joint damage over time.

Weight management

Maintaining a healthy weight reduces excess stress on the joints and may reduce the rate of cartilage loss.

Quit smoking

As this is a risk factor for the development of osteoarthritis, quitting smoking and avoiding secondhand smoke may reduce the symptoms of SBCs and OA.

Ultrasound therapy

At least one study suggests that delivering localized ultrasonic therapy to cartilage and subchondral bone may help treat OA. However, much more research is needed in this area.

Physical therapy

According to the American Academy of Family Physicians, mild degenerative joint disease, of which SBCs may be a feature, can be treated with physical therapy.

If present, symptoms of SBCs can include:

  • discomfort
  • pain
  • lack of flexibility in the joint
  • swelling or bulging around the joint

There are only a few symptoms associated with SBCs, as they are typically considered to be a symptom of OA, particularly progressive OA.

SBCs are considered a symptom of OA or other joint conditions. They may resolve on their own or persist long-term. SBCs may cause pain and contribute to disease progression.

The best way to treat these cysts is to manage the symptoms of OA and other joint conditions.

Subchondral bone cyst: Causes, treatment, and symptoms

Subchondral bone cysts are sacs of fluid that form inside a person’s joints. The cysts occur in the subchondral bone, the layer of bone just under the cartilage.

The subchondral bone acts as a shock absorber in weight-bearing joints, such as the knees, hips, and shoulders. The liquid inside subchondral bone cysts (SBCs) is hyaluronic acid, a component found in synovial fluid, which is the thick substance that lubricates joints, allowing the bones to slide past one another without friction.

Risk factors for SBCs include obesity and smoking, but the precise cause is unknown. Symptoms include joint pain and discomfort. Lifestyle changes help symptom relief and may prevent the formation of other SBCs.

Fast facts on SBCs:

  • Initially discovered in the 1940s, SBCs are a sign of osteoarthritis (OA).
  • The exact cause of SBCs is not known.
  • Engaging in high-impact activities can contribute to injury and damage to the joint and cartilage over time, possibly leading to SBCs.
  • SBCs are diagnosed using imaging tests, such as X-rays.

Some experts believe that SBCs are a precursor to osteoarthritis (OA), which itself is a painful condition affecting more than 30 million adults in the United States.

OA causes the cartilage and bones within a joint to gradually break down. SBCs are considered one of the four cardinal or key radiological findings for OA.

However, in one large study of 806 people with OA in the knee, SBCs were found in only 30.6 percent of them. Other conditions besides OA, such as rheumatoid arthritis, also cause cysts to form on the bone joints.

Though the cause is unknown, it is thought SBCs are the result of repeated stress to the bone. This stress is caused by increased pressure from quicker blood flow to the subchondral bone, something that is seen in people with OA.

Certain characteristics and behaviors can increase the risk of developing an SBC. These include:

  • Sex – women may have a higher risk than men of SBC formation, according to some research.
  • Heredity – as certain forms of OA may be hereditary, people with a family member with the condition are more likely to develop OA and SBCs.
  • Joint alignment and shape – abnormal joint shape or alignment can increase friction, leading to greater damage and a higher risk of cyst formation.
  • Obesity – carrying excess weight puts additional pressure on the joints of the body, increasing the risk of joint problems.
  • Smoking – tobacco contains chemicals that contribute to cartilage damage. Some research has shown that male smokers with OA experience greater cartilage loss.
  • Activity and injury – joint injuries increase the risk of joint problems later, including the development of SBCs.

It is recommended that SBCs are not treated directly. Due to the risk of infection, these cysts should not be removed. However, they can regress on their own.

As a result, treatment typically involves making lifestyle changes and providing symptom relief. Some people may benefit from replacing the joint if problems are ongoing or progressive.

Treatments for SBCs include the following:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

These over-the-counter painkillers, such as ibuprofen and aspirin, may reduce symptoms of SBCs. It is always advisable to check with a doctor before taking NSAIDs. Long-term use should be avoided.

Low-impact activities

It may be recommended to choose low-impact activities such as swimming, aqua aerobics, and cycling. These put less pressure on the knees and hips joints than high-impact activities, such as running and jumping, which can exacerbate the symptoms of OS and SBCs and lead to further joint damage over time.

Weight management

Maintaining a healthy weight reduces excess stress on the joints and may reduce the rate of cartilage loss.

Quit smoking

As this is a risk factor for the development of osteoarthritis, quitting smoking and avoiding secondhand smoke may reduce the symptoms of SBCs and OA.

Ultrasound therapy

At least one study suggests that delivering localized ultrasonic therapy to cartilage and subchondral bone may help treat OA. However, much more research is needed in this area.

Physical therapy

According to the American Academy of Family Physicians, mild degenerative joint disease, of which SBCs may be a feature, can be treated with physical therapy.

If present, symptoms of SBCs can include:

  • discomfort
  • pain
  • lack of flexibility in the joint
  • swelling or bulging around the joint

There are only a few symptoms associated with SBCs, as they are typically considered to be a symptom of OA, particularly progressive OA.

SBCs are considered a symptom of OA or other joint conditions. They may resolve on their own or persist long-term. SBCs may cause pain and contribute to disease progression.

The best way to treat these cysts is to manage the symptoms of OA and other joint conditions.

Subchondral Bone Cysts in People With Osteoporosis

A subchondral bone cyst (SBC) is a fluid-filled sac that forms in the bone just beneath the cartilage of a joint such as the hip, knee, or shoulder. They can develop in people with osteoarthritis and are usually not treated.

How Osteoarthritis Progresses

Osteoarthritis is caused by the breakdown of cartilage in the joints. Cartilage serves as a cushion between joint bones, allowing them to glide over each other and absorb the shock from physical movements.

Osteoarthritis typically develops in stages:

  1. At the onset of disease, the space between the joint bones will begin to narrow due to cartilage degeneration.
  2. As the joint tries to repair itself, the remodeling of bone can often be haphazard and lead to the formation of bone spurs (osteophytes) and the development of subchondral sclerosis (the stiffening of the joint due to increased bone mass).
  3. As cartilage loss continues, SBCs may begin to form.
  4. The increasing depletion of cartilage will eventually cause bone to rub against bone, triggering pain and the loss of mobility.

Causes and Symptoms

Subchondral bone is the layer of bone just below the cartilage. With osteoarthritis, the blood supply to these areas is typically increased as the body tries to repair the joint damage. Damage to the subchondral bone and overlying cartilage are key factors, but exactly how SBCs form remains unknown.

Together with bones spurs and increased bone mass, the formation of SBCs can further complicate the symptoms of osteoarthritis. From a symptomatic standpoint, SBCs are not all that distinctive and may cause mild to moderate pain and/or affect joint flexibility.

Not all people with osteoarthritis will develop SBC, and it is not even entirely clear why some people develop the condition and others don’t.

Diagnosis

SBCs are diagnosed with an X-ray. hey will appear as hollowed-out areas in the subchondral bone but are often poorly defined and difficult to spot. They will appear as hollowed-out areas in the subchondral bone but are often poorly defined and difficult to spot. In such cases, a magnetic resonance imaging (MRI) scan may be ordered to provide the doctor a more three-dimensional view.

This, along with a review of the person’s symptoms and risk factors, is usually enough to confirm the diagnosis.

The risk factors for SBC include:

  • Obesity
  • Smoking
  • Abnormal joint alignment
  • Abnormal joint shape
  • Prior joint injury
  • A family history of osteoarthritis

Treatment

SBC is not treated directly. Instead, the doctor will find ways to help alleviate the acute and long-term symptoms of the underlying osteoarthritis.

Options may include:

If none of these options provide relief, the doctor may recommend a joint replacement surgery.

An atypically located large subchondral cyst in an osteoarthritic hip joint: a case report | Journal of Medical Case Reports

A 74-year-old Turkish man was referred to our out-patient clinic because of right hip pain without a history of trauma. He had experienced severe pain in the groin on weight bearing, with variable degree of pain at rest, over the last 45 days. He was able to walk only with the assistance of crutches. His medical history was unremarkable.

On physical examination, he was afebrile and had a blood pressure of 120/80mmHg. His active ranges of motion (ROM) for both hips were restricted in all directions and the passive ROM of right hip was painful in flexion, abduction and internal rotation. The result of a Thomas test was positive for the right hip.

Antero-posterior and frog-leg pelvis radiographs (Figure 1) showed lucent and sclerotic regions in both the femur and acetabulum with loss of articular joint distance and flattening especially in the right femoral head, which indicated severe degenerative coxarthrosis. Magnetic resonance imaging (MRI) scans revealed a cystic lesion located on the medial side of the iliac bone, which had a uniformly bounded capsule and contained serpentine-like structures (Figure 2A,B). On an axial MRI image (Figure 2C), the cystic lesion was seen to reach antero-medially to the hip joint and had eroded the adjacent acetabulum. The results of an abdomino-pelvic ultrasound indicated a grade I hepatosteatosis and 40mm calcified cortical cyst located on the upper pole of the right kidney. The results of standard laboratory tests revealed a normal level of hemoglobin (13.1g/dL), hematocrit (38) and white blood cell (6.48mm3/μL) counts. The results of functional tests for the kidney and liver, as well as other biochemical blood analyses, were normal.

Figure 1

Antero-posterior (A) and frog-leg (B) pelvis radiographs showing sclerotic changes in both acetabulum, loss of articular joint distance, osteophytes and degenerative changes in both hips, which indicate severe degenerative coxarthrosis.

Figure 2

Coronal (A and B) and axial (C) magnetic resonance imaging scans. Coronal T2-weighted fat-saturated (A) and T1-weighted fat-saturated contrast-enhanced (B) magnetic resonance imaging scans showing a cystic lesion located on the medial side of the right iliac bone. The cyst is associated with the adjacent acetabulum (white arrow) on the axial fat-saturated magnetic resonance imaging scan (C).

Surgery for excision of the cystic lesion was recommended, and was performed under general anesthesia. Our patient lay in a supine position and an anterior ilioinguinal incision was made in the right hip. The interval between the tensor fascia lata and sartorius muscle was identified. The lateral femoral cutaneous nerve was retracted laterally. The dissection was extended proximally to expose the medial surface of the iliac bone. The rectus femoris muscle was not incised from its attachment to the upper part of the acetabular rim, but was instead retracted laterally. The iliacus muscle was identified and stripped from the medial surface of the iliac bone. The cystic lesion was identified. There were no adhesions between the cyst membrane and surrounding soft tissue. However, it was associated with the antero-medial acetabular wall and had eroded the adjacent acetabulum. The cystic lesion was resected en bloc and examined in the operating room on the surgical table. Calcified necrotic material was exposed in the cyst.

Our patient had an uneventful post-operative course with no complications. Post-operative prophylaxis of intravenous antibiotics, consisting of a first-generation cephalosporin (cefazolin, 1g every eight hours) and an aminoglycoside (gentamycin 5mg/kg/day) were continued 48 hours after the surgery and low-molecular-weight heparin prophylaxis was administered for 10 days. Active and passive hip ROM exercises were started on the second day post-operatively with mobilizing on crutches, and he was discharged from hospital on the third post-operative day. Full weight bearing without support was allowed at the third post-operative week. The histopathological results of tissue samples were found to be consistent with an osteoarthritic cyst that contained degenerative calcified and necrotic chondroid tissue and bone trabeculae (Figure 3).

Figure 3

Histopathologic investigation of the cystic lesion (A) and cyst membrane (B). Histopathologic investigation of the cystic lesion (A) shows necrotic bone trabeculae and chondroid tissue (hematoxylin and eosin stain, ×400). Histopathological view of the cyst membrane (B) (hematoxylin and eosin stain, ×200).

There were no complications such as infection and skin necrosis during the follow-up period. At the final follow-up (4 months post-operatively), our patient was assessed clinically. The active ROM for both hips were restricted as had been the case pre-operatively. However, he had only slight pain in his right hip and was able to walk without support. Primary total hip replacement surgery for both hips was recommended in view of the radiological findings.

How do cysts form in the pathogenesis of osteoarthritis (OA)?

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  • 90,000 Modern view on the problem of coxoarthrosis treatment

    Coxarthrosis – a degenerative disease of the hip joint, characterized by a progressive course and impaired statodynamic function of the musculoskeletal system. Since the hip joint is the most powerful joint in the human body and undergoes great stress in the process of vital activity, there is nothing surprising in the fact that diseases of this joint are ranked second after back pain.

    Distinguish coxarthrosis primary (idiopathic, i.e. of unclear etiology) and secondary coxarthrosis, which occurs against the background of hip dysplasia or congenital dislocation of the hip, as a result of trauma, inflammation in the joint.

    The reasons are different in all cases – the clinic is the same.

    The main complaint of patients with coxarthrosis is pain. But the nature, intensity, duration and localization of this pain depend on the severity of the dystrophic process in the joint, i.e.e. from the stage of coxarthrosis. There are three stages of coxarthrosis.

    In of the first stage periodically after physical exertion (long walking, running) pain occurs in the hip joint, less often in the hip or knee joint. As a rule, after rest, the pain disappears. The range of motion in the joint is not limited, muscle strength is not changed, gait is not disturbed. On radiographs, minor bone growths are visible that do not go beyond the articular lip.They are usually located around the outer or inner edge of the articular surface of the acetabulum. The head and neck of the femur are practically unchanged. The joint gap is unevenly slightly narrowed.

    In of the second stage pains are more intense, radiate to the thigh, groin area, occur at rest. Joint function is impaired. First of all, internal rotation and hip abduction are limited, i.e. flexion and adduction contracture is formed.The strength of the muscles abducting and extending the thigh decreases, their hypotension and hypotrophy are determined. Therefore, when walking, lameness begins to appear. On the roentgenogram, significant bone growths are visible along the outer and inner edges of the acetabulum, extending beyond the cartilaginous lip. Deformation of the femoral head, its enlargement and contour irregularity are noted. Cysts can form in the most stressed part of the head and acetabulum. The femoral neck is thickened and widened. The joint gap is unevenly narrowed (up to 1 / 3-1 / 4 of the original height).There is a tendency towards displacement of the femoral head.

    In of the third stage pains are permanent, occurring even at night. When walking, patients are forced to use a cane. A sharp limitation of all movements in the joint (flexion-adduction contracture) and hypotrophy of the gluteal muscles, as well as the muscles of the thigh and lower leg, are noted. There is a tilt of the pelvis in the frontal plane, which leads to a functional shortening of the limb on the affected side. The patient is forced to step on the toes in order to reach the floor, and to tilt the body to the affected side when walking to compensate for the tilt of the pelvis and shortening of the limb.This compensation mechanism leads to a shift in the center of gravity and an overload of the joint. On roentgenograms, extensive bone growths are determined from the side of the roof of the acetabulum and the head of the femur, a sharp narrowing of the joint space. The femoral neck is significantly widened and shortened.

    Unfortunately, there is still no unified theory of the pathogenesis of coxarthrosis. Most scientists believe that the starting point is impaired blood circulation in the joint due to both deterioration of venous outflow and impaired arterial inflow.As a result of tissue hypoxia, under-oxidized metabolic products accumulate, activating proteolytic enzymes and hyaluronidase of the synovial fluid, which destroy the proteoglycans of the cartilage. Its thinning, razvlechenie, fragmentation occurs, depreciation properties are lost. As a compensatory reaction of the articular surfaces of the hip joint, marginal bone growths are formed. In the future, sclerosis develops and cysts are formed in the articulating sections of the femoral head and acetabulum.

    Treatment of coxarthrosis due to the lack of a single pathogenetic mechanism for the development of the disease is symptomatic. Its purpose is to reduce pain, for which analgesic and anti-inflammatory drugs (analgin, indomethacin, ortofen, etc.) are used. To improve the redox processes in the cartilage tissue, chondroprotectors, vitamins, rumalon and other drugs are prescribed. In a polyclinic, electrophoresis of a solution of novocaine, Dimexidum, as well as ultrasound therapy, magnetotherapy, and laser therapy are used.After reducing the pain syndrome, manual massage of the lumbar region, hip joint, hip and therapeutic exercises (kinesitherapy) is recommended.

    Now we get to the most interesting question of this article. For us, kinesitherapists, it is obvious that therapeutic exercises in the treatment of coxarthrosis should take not the last, but the first, more precisely, the leading place. Is it possible to consider a joint disease in isolation from its inseparable component – muscles and ligaments? Indeed, without their direct action, a joint is a set of bone structures, and nothing more.The ancient Greeks said: “The body is a single whole, heal the patient, not the disease.” The human body is perfect, there is nothing superfluous in it. And just as in nature, the death of a mosquito leads to the death of entire populations of birds, so in the human body, the loss of the quality of any muscle group, for example, hypotrophy of the adductor and abductor muscles of the thigh in coxarthrosis, leads to the loss of a large section of the vascular network feeding the joint (for reference : there are 3-4 capillaries in one muscle fiber). And then what can we expect from drug therapy? After all, anyone understands that the drug is delivered to the point of action with the blood stream.And we have ischemia and dystrophy in the joint area. How much of the drug gets into the joint in this position? Scanty …

    Therefore, in the first place in the treatment of coxarthrosis, we must put precisely physiotherapy exercises (kinesitherapy), which will allow us to influence the joint at the level of the pathogenesis of the disease, thus ensuring the maximum effectiveness of the drug treatment carried out in parallel. After all, the “pumping” function of the muscles cannot be replaced by any other procedures.And only having restored the trophism of the joint, we can count on the regeneration processes in it. And with existing defects in the structure of the joint, it is necessary to ensure the maximum level of safety of physical work with it.

    For this, power trainers with a strictly specified geometry of movements are used.

    The centers of modern kinesitherapy use MTB (multifunctional Bubnovsky simulator), which received a certificate in July 2011 as a means of medical rehabilitation.The main advantage of MTB is the possibility of decompression work with the affected joint under conditions of individual selection of the load when performing each exercise. The treatment program for each patient is drawn up individually, based on the results of myofascial testing. The testing determines the functionality of the musculoskeletal system, i.e. strength of individual muscle groups, the ability to move in the joints, the condition of the muscles of the upper limb and back. In addition, the motor reaction of the muscles is determined, that is, the time spent on the possibility of performing the next exercise; learning technique of movements and diaphragmatic breathing, which is necessary to reduce intra-abdominal pressure when performing strength exercises.

    Implementation of the prescribed treatment program takes place on an individual basis, under the supervision of an instructor-methodologist of exercise therapy. Our experience shows that a well-trained muscular system helps to develop compensatory mechanisms even in case of gross disorders in the joint. But it would be better not to inform them …

    Recently a patient asked me a question that I could not answer. For several years she wandered to different doctors (rheumatologists, surgeons, orthopedists) with one diagnosis – second degree coxarthrosis.Treatment was prescribed – there was no improvement in well-being. After studying at our center for a month, she noticed a clear positive trend and asked: “Why was I not referred to you for treatment earlier? Aren’t our doctors interested in the patient’s recovery? ”

    No, I do not believe that our doctors do not want the benefit of their patients. The role of sensible exercise in treating joint disease is likely simply underestimated. But in vain … After all, back in 1786, Professor N.M. Maksimovich-Ambodik said: “A body without movement is like stagnant water that grows moldy, deteriorates, rots” .

    So let’s not bring it to this!

    Physician of exercise therapy and sports medicine

    E.I. Vlasova

    90,000 causes, symptoms, diagnosis, treatment, prevention

    It is a pathological cavity resulting from a violation of local blood circulation and activation of enzymes that provoke the destruction of bone organic matter.

    Causes

    The trigger for the formation of a bone cyst is a violation of blood circulation in a limited area of ​​the bone. As a result of a lack of oxygen and nutrients, such a site begins to collapse, which is accompanied by the activation of lysosomal enzymes that break down collagen, glycosaminoglycans and other proteins. A cavity is formed, filled with a liquid that has a high hydrostatic and osmotic pressure. High pressure, combined with an increased content of enzymes in the fluid inside the cyst, provokes further destruction of nearby bone tissue.Subsequently, the pressure of the fluid decreases, the activity of enzymes also decreases, from an active cyst it turns into a passive one and disappears over time, gradually being replaced by new bone tissue.

    Symptoms

    A solitary bone cyst develops more often in boys aged 10 to 15 years, the formation of a pathological formation is possible earlier. In adults, such cysts are detected very rarely and most often they represent a residual cavity that forms after a disease suffered in childhood.Most often, such formations are formed in long tubular bones. At the initial stages, the disease is asymptomatic, in rare cases, in the area of ​​localization of the pathological focus, slight swelling and unexpressed pain may be noted. With large cysts, localized in the proximal femur diaphysis, lameness may occur, with damage to the humerus, unpleasant sensations and discomfort with sudden movements and raising the arm.

    On visual examination of patients with the initial stage of the disease, local changes are weakly expressed.In the area of ​​localization of the cyst, there is no edema or redness, the venous pattern on the skin is not pronounced, local and general hyperthermia are absent. In rare cases, slight muscle atrophy is found.

    Palpation sometimes reveals a painless clavate thickening with bone density. With large cysts, when pressed on its walls, they can slightly bend. At the same time, active and passive movements and support on the limb are preserved.In the case of a violation of the integrity of the bone, the clinical picture corresponds to a fracture, but the symptoms are less pronounced than in the case of a conventional traumatic injury.

    Aneurysmal bone cysts are much less common than solitary cysts. This pathological formation is most often detected in girls aged 10 to 15 years. Sometimes there is a lesion of the bones of the pelvis and vertebra, less often the metaphyses of long tubular bones suffer. This pathological process in most cases occurs after an injury.During the formation of the cavity, the patient develops an intense pain syndrome, accompanied by the appearance of progressive edema in the affected area. On visual examination in the area of ​​the pathological focus, local hyperthermia and expansion of the saphenous veins are determined. When the focus is located in the bones of the lower extremities, a violation of the support is revealed. Quite often, the pathological process is accompanied by the formation of a contracture of the nearby joint. With localization of bone cysts in the vertebrae, neurological disorders may occur due to compression of the spinal roots.

    Diagnostics

    If a bone cyst is suspected, an X-ray examination of the affected segment may be prescribed to the patient to clarify the type of formation.

    Treatment

    When treating a bone cyst, the patient is recommended to unload the affected limb. In case of damage to the lower limb, the patient is recommended to use crutches when moving. If a pathological fracture occurs, the patient is put in a plaster cast for at least six weeks.To accelerate the maturation of the tumor formation, it is punctured. When carrying out this manipulation, the contents of the cyst are removed using special needles for intraosseous anesthesia. After that, multiple perforations of the walls are performed to reduce the pressure inside the cyst. The cavity is washed with distilled water or saline solution to remove cleavage products and enzymes. At the next stage, washing with 5% aminocaproic acid solution is performed to neutralize fibrinolysis, after which aprotinin is injected.

    Prevention

    Prevention of bone cysts is based on the timely treatment of any diseases that may cause circulatory disorders in the bone area.

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    Cyst of the head of the humerus as a consequence of local administration of betamethasone (case from practice) | Kogan

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    48.Clark S., Evans J.M., Armstrong N., Schnitz W. Tophaceous gout with rare involvement of the patella. Radiol Case Rep. 2016; 11 (4): 380-385. doi: 10.1016 / j.radcr.2016.07.002.

    49. Mahapatro R.C., Sylvia L.C., Becker S.M. Case report: i traosseous gouty tophus. J Med Soc N J. 1985; 82 (1): 41-42.

    50. Snoddy M.C., Lee D.H., Kuhn J.E.Charcot shoulder and elbow: a review of the literature and update on treatment. J Shoulder Elbow Surg. 2017; 26 (3): 544-552. doi: 10.1016 / j.jse.2016.10.015.

    51. Su J., Al-Delfi F., Mills G., Peddi P. Charcot’s o arthropathy mimicking an osteosarcoma of humerus. BMJ Case Rep. 2016; 2016. pii: bcr2015212638. doi: 10.1136 / bcr-2015-212638.

    52.Buckley S.L., Alexander A.H., Barrack R.L. Scapular osteomyelitis. An unusual complication following subacromial corticosteroid injection. Orthop Rev. 1989; 18 (3): 321-324.

    53. Birkinshaw R., O’Donnell J., Sammy I. Necrotising fasciitis as a complication of steroid injection. J Accid Emerg Med. 1997; 14 (1): 52-54. doi: 10.1136 / emj.14.1.52.

    54.Yangco B.G., Germain B.F., Deresinski S.C. Case r port. Fatal gas gangrene following intra-articular steroid injection. Am J Med Sci. 1982; 283 (2): 94-98. doi: 10.1097 / 00000441-198203000-00008.

    55. Beissert S., Presser D., Rütter A., ​​Metze D., Luger T.A., Schwarz T. [Embolia cutis medicamentosa (Nicolau syndrome) after intra-articular injection]. Hautarzt. 1999; 50 (3): 214-216. (In German).

    56.Christensson B., Ryd L., Dahlberg L., Lohmander S. Candida albicans arthritis in a nonimmunocompromised patient. Complication of placebo intraarticular injections. Acta Orthop Scand. 1993; 64 (6): 695-698.

    57. Nichols AW. Complications associated with the use of corticosteroids in the treatment of athletic injuries. Clin J Sport Med. 2005; 15 (5): 370-375. doi: 10.1097 / 01.jsm.0000179233.17885.18.

    58.Cheng J., Abdi S. Complications of joint, tendon, and muscle injections. Tech Reg Anesth Pain Manag. 2007; 11 (3): 141-147. doi: 10.1053 / j.trap.2007.05.006.

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    90,000 MRI of the knee joint (knee): what reveals when prescribed

    In his daily practice, a doctor often faces a choice – which diagnostic method to choose for examining a patient with joint diseases? The classical X-ray method reveals only a small part of the deviations from the norm, affecting mainly the bone tissue.Due to the physical characteristics of X-ray radiation, we do not see any disturbances in the structure of the so-called soft tissue component, which are the main factor in dysfunction in trauma and degenerative-dystrophic diseases of the musculoskeletal system. Being “missed”, these changes pose a serious threat to the deterioration of the quality of life of patients, up to their disability.

    Do you want to know what is the danger of X-rays? Read here

    What to choose: X-ray, magnetic resonance imaging, arthrography or ultrasound of the knee joint?

    Are there any advantages to MRI of the knee joint over other methods?

    In the traumatological and orthopedic aspect, the main advantage of MRI compared to X-ray research methods is the ability to visualize soft tissues at the studied level.Ligaments, menisci, synovial folds are not an exception.

    With the advent of MRI, the need to perform arthrography with intravenous contrast has disappeared, and, in contrast to ultrasound, magnetic resonance imaging allows visualization of both soft tissues and cancellous bones, with less dependence on the qualifications of the operator.

    The use of pulse sequences with suppression of the signal from fat makes it possible to differentiate zones of contusion (trabecular edema) in the bone, and T2-weighted mapping of articular cartilage on 3-Tesla MRIs allows you to accurately determine the stage of osteoarthritis.

    MRI of the knee joint allows detecting infiltrative changes and destruction of bone tissue, bone marrow replacement even before the appearance of radiologically detectable changes. Based on this, MRI is the method of choice for reliable diagnosis and early detection of avascular necrosis of the femoral heads, stress and radiographically hidden fractures.

    Find out the cost of MRI of the knee joint

    The sensitivity and specificity of MRI in detecting skeletal metastases has surpassed the capabilities of bone scintigraphy, especially since the advent of tomographs with the possibility of simultaneous examination of the whole body.

    Whole body MRI: when is it needed?

    What diseases can be detected by MRI of joints?

    Among them: degenerative-dystrophic diseases, traumatic injuries, inflammatory and tumor diseases.

    DEGENERATIVE-DYSTROPHIC DISEASES OF THE JOINTS – what is it?

    Degenerative-dystrophic diseases of bones and joints are a group of pathological processes resulting from local, regional and systemic disorders of trophism and metabolism.

    The variety of clinical manifestations and variants of the course, features of damage to the articular and periarticular tissues significantly complicates the clinical and radiological diagnosis of these diseases.

    The introduction into clinical practice of MRI, which has a high-contrast image of soft tissue, cartilaginous, fibrous and bone structures, made it possible to obtain more complete information about pathological changes in both X-ray-positive and retro-negative structures of the osteoarticular apparatus at various stages of money-degenerative-dystrophic processes.

    Osteoatrosis is one of the most common diseases of the osteoarticular system in adults, caused by primary damage to the articular cartilage.

    What happens with osteoarthritis?

    Degenerated articular cartilage loses its elastic buffer properties, is replaced by coarse-fibrous tissue, cracks appear in it, in places the cartilaginous cover can be completely destroyed. The articular cartilage loses its shock-absorbing properties, and, as a result, the load on the articular surfaces increases sharply.

    This leads to their compaction, deformation and growth of marginal osteophytes. The lost function of the articular cartilage is compensated by an increase in the area of ​​contacting surfaces, as well as due to osteosclerotic restructuring of the most loaded subchondral regions.

    Further, this leads to their deformation, which is accompanied by an increasing restriction in the joint. Nevertheless, with osteoarthritis, there is never bone ankylosis and at least minimal swinging movements are always preserved.Due to irritation of the synovium with fragments of necrotic cartilage, a secondary inflammatory process (reactive synovitis) occurs.

    In the knee joint it is noted:

    – decrease in the height of the joint space of varying severity;

    – subchondral osteosclerosis;

    – the presence of marginal bone growths of the articular surfaces.

    In later stages:

    – deformation of the epiphyses of the bones;

    – regional osteoporosis;

    – hypotrophy of periarticular soft tissues.

    What are the symptoms of osteoarthritis of the joints?

    Stages of osteoarthritis

    Stage I is clinically manifested by moderate pain in the joints that occurs in the morning, during the first movements (early osteoarthritis).

    At this stage, MRI allows visualization of uneven thinning of the articular cartilage, as well as degenerative changes in the menisci, cruciate and collateral ligaments.

    In addition, linear areas of subchondral fibrosis of the bone marrow are visualized on MRI; small marginal bone growths.

    Stage II (moderate osteoarthritis) is clinically manifested by pain in the joints when moving throughout the day, crunching in the joints.

    Do you want to know why joints creak and crunch?

    At this stage of osteoarthritis, MRI reveals the unevenness of the contour, thinning and single areas of destruction of the articular cartilage, areas of subchondral fibrosis, marginal bone growths, degenerative changes in the ligaments and fibro-cartilaginous structures.

    Signs of secondary exudative synovitis, accompanied by areas of bone marrow edema in the subchondral regions, and the presence of subchondral cysts, can also be detected.

    Stage III (severe osteoarthritis) is clinically manifested by such signs as: significant limitation of movement in the joint, severe pain during movement, atrophy of the periarticular tissues, external defiguration of the joint.

    At this stage, MRI reveals a complex of pathological changes in bone structures, rough marginal osteophytes, erosion of articular surfaces, bone marrow fibrosis in the subchondral regions, changes in the shape and size of bones.

    On magnetic resonance imaging, extended areas of degeneration of the articular cartilage up to its complete absence, gross degeneration of ligaments and fibro-cartilaginous structures, proliferation of fibrous tissue in the joint cavity are visualized.

    For IV stage (outcome of osteoarthritis) – the formation of fibrous ankylosis is characteristic.

    Clinically manifested by the absence of movement in the joint.

    On MRI at IV stage of osteoarthritis – complete absence of images of articular cartilage, menisci and ligaments, gross erosion of the subchondral layer, rough marginal bone growths and deformation of the epiphyses, atrophic changes in paraarticular soft tissues.

    TRAUMATIC JOINT DAMAGE

    Traumatic injuries of menisci

    Degrees of damage to menisci:

    I Art. – unexpressed central degeneration – changes inside the meniscus due to an increase in the intensity of MRS, without connection with the joint cavity;

    II Art. – widespread central degeneration – a wider area of ​​increased MRS intensity, may have a linear shape, without connection with the joint cavity;

    III Art.- meniscus rupture – increased intensity of MRS inside the meniscus with a rupture of the intra-articular space contour, can be combined with a change in the position of meniscus fragments or a stepwise deformation of the contour (the so-called “notch” symptom).

    How will MRI help a football player? By the doctor-radiologist of LLC “MRT Expert Vladivostok”

    He Sergey Mansikovich

    Traumatic injuries of ligaments

    In the figure – norm

    MR signs of pathological changes in case of ligament injuries / complete rupture /

    The figure shows signs of complete rupture: no visualization in a typical place, break of all fibers, hemarthrosis

    In the picture – MR signs of pathological changes in case of ligament injuries / partial rupture /

    In the figure – there is a local increase in the signal, a break in single fibers.

    In the figure – thickening, expansion, diffuse increase in the MR signal from the collateral ligament

    In the figure – thickening, expansion; diffuse increase in the MR signal

    What does an isolated soft tissue injury of the knee look like on MRI? See drawing.

    In the figure – MRI of the knee joint in the sagittal projection (T2 + FS).

    Stretching m.gastrocnemius.

    Zone of increased MR signal and thickening of the medial head m. gastrocnemius (1)

    INFLAMMATORY DISEASES OF THE JOINTS

    MRI significantly expands the capabilities of radiological diagnosis of inflammatory diseases of the osteoarticular system due to the ability to most fully assess the localization and prevalence of lesions of synovial, cartilaginous, fibrous and bone articular structures at different stages of the pathological process.

    Rheumatoid arthritis

    What degrees of rheumatoid arthritis are there?

    Clinical and radiological classification of rheumatoid arthritis (RA) includes:

    1. first (early) stage;

    2. second (moderate) stage;

    3. third (severe) stage;

    4.fourth stage (exodus stage)

    The first (early) stage of rheumatoid arthritis clinically manifests itself as joint stiffness in the morning, pain that passes during the day.

    Objectively, the joints are not changed. On radiographs, pathological changes, as a rule, are absent / or sometimes this stage of rheumatoid arthritis is radiographically manifested by osteoporosis of the metaepiphysis in the absence of destructive changes in the joints.

    The main advantage of MRI in the diagnosis of rheumatoid arthritis is the ability to visualize the characteristic signs of damage to the synovial membrane of the joint.

    MRI reveals the exudative phase of acute synovitis, synovial hypertrophy along the articular surface of the capsule and around the ligaments.

    Say NO to Arthritis! What is arthritis? Why does this disease develop? Tells

    Matsiev Deniz Ruslanovich – radiologist, MRT Expert Sochi LLC

    In addition, MRI scans show bone marrow edema in the subchondral regions, periarticular soft tissue edema and periarticular synovial cysts.

    In the figure – MRI of the knee joint T2-VI sagittal and axial planes.

    exudative phase of acute synovitis, synovial hypertrophy

    The second (moderate) stage of rheumatoid arthritis is clinically manifested by stiffness and soreness in the joints during the day, with objective examination – moderate atrophy of periarticular soft tissues. Radiographically determined osteoporosis, as well as marginal usures in typical places of attachment of the articular capsule. There is no joint deformation.

    At this stage, MRI reveals signs of chronic proliferative synovitis and the initial manifestations of articular cartilage damage / contour irregularity and areas of destruction /, fibrous structures / degeneration / and underlying bone structures / marginal usures and subchondral erosion of articular surfaces /, areas of edema and bone fibrosis tissues, periarticular synovial cysts of different sizes.

    In the figure – MR-tomogram of the knee joint (T1-VI)

    Stage II rheumatoid arthritis is characterized by:

    – joint effusion;

    – degeneration of the posterior horn of the meniscus;

    – subchondral erosion of the femur;

    – thinning of the articular cartilage

    The third (severe) stage of rheumatoid arthritis is clinically manifested by joint stiffness, significant limitation of their range of motion, painfulness at rest and during movements, pronounced deformities.

    Radiologically diagnosed: signs of cartilage and bone destruction / subchondral erosion and marginal usuration /, narrowing of the joint space by more than 50% of the norm, pronounced subchondral sclerosis, regional osteoporosis up to bone atrophy, small subchondral cysts; various types of deformation of the epiphyses of the bones – subluxation, deviation of the axis of the limb, hyperextension of the joints. Signs of pronounced muscle atrophy, changes in intra-articular soft tissues (nodes, tenosynovitis) are determined, contractures develop without signs of ankylosis.

    At this stage, MRI reveals a complex of pronounced proliferative changes in the joint cavity with the formation of a massive fibrous pannus filling the intra-articular space; multiple defects of articular cartilage, up to complete absence; severe degeneration and thinning of the ligaments, degenerative changes in the menisci, changes in their shape and fragmentation.

    Also, this stage is characterized by pronounced erosion of the articular surfaces, fibrosis of the bone marrow in the subchondral regions, the presence of subchondral and intraepiphyseal cysts, marginal bone growths, deformation and subluxation of the bones.

    In the figure – MRI of the knee joint T2-WI + FS in the coronal and T1-WI in the sagittal plane.

    multiple defects of articular cartilage, up to complete absence; severe degeneration and thinning of the ligaments, pronounced degenerative changes in the menisci, fragmentation; pronounced erosion of the articular surfaces; deformation and atrophy of bones

    The fourth stage of rheumatoid arthritis (outcome) clinically manifests itself as the formation of fibrous ankylosis.This stage is characterized by: lack of movement in the joint, defiguration and atrophy of the periarticular bone tissues.

    X-ray: absence of joint space, gross subchondral sclerosis, regional osteoporosis with signs of bone tissue atrophy, usuration of endplates, massive marginal bone growths, gross bone deformities.

    MRI picture: the presence of fibrous tissue (pannus) in the joint cavity, no image of the articular cartilage, menisci, cruciate ligaments.Severe fibrosis of the bone marrow in the epiphyses of the bones, erosion, marginal bone growths of the articular surfaces, atrophy of paraarticular tissues, gross changes in the shape and ratio of bones.

    The figure is an MRI scan of the knee joint in coronal projection (T1).

    Rheumatoid arthritis. Stage IV:

    • areas of fibrosis in the joint cavity

    • marginal usures and bone growths of articular surfaces (1),

    • no image of articular cartilage and menisci (2),

    • subchondral fibrosis in the epiphyses of bones (3).

    Purulent destructive arthritis, multiple foci of femoral bone marrow infarction.

    In the figure – synovial hypertrophy is a characteristic MR-sign of the inflammatory process in the joint

    TUMOR DISEASES OF THE JOINTS

    They manifest themselves in different ways depending on the aggressiveness of the neoplasm, the nature and rate of its growth in the bone marrow canal. Based on the features of MR symptoms, 2 groups of neoplasms are distinguished:

    – expansive;

    – infiltrative.

    What are expansive tumor diseases of the joints? These are benign and slow-growing malignant tumors.

    On MRI they are visualized as delimited volumetric formations of medium and low intensity MRS on T1 and high on T2. In most cases, they are clearly separated from the medullary canal by a low-intensity zone of endosteal ossification, which has a scalloped or jagged contour.

    What are infiltrative tumor diseases of the joints? These tumors are malignant and highly aggressive.They are characterized by rapid spread in the medullary canal in the longitudinal and transverse directions; along and between the bone beams leading the destruction of bone tissue.

    On MRI – a massive area of ​​bone marrow infiltration with uneven fuzzy contours, ranging in size from small foci to diffuse lesions, along the periphery (at the border in the unaffected bone marrow) the area of ​​edema is determined. A large extent of the infiltration zone is characteristic in comparison with the destruction zones visible on X-ray and CT.

    Bone marrow malignant tumors, growing mainly in the longitudinal direction in the medullary canal, in the early stages can manifest themselves as small focal infiltration of the bone marrow of the “tissue eaten by moths” type. The structure depends on the tumor matrix (cartilaginous, fibrous, bone, soft tissue) and can be heterogeneous due to the presence of septa, cystic cavities, foci of hemorrhage, calcification and ossification.

    The figure shows a giant cell tumor of the distal metaepiphysis of the femur.

    Visible: formation of low intensity in the distal metaepiphysis of the femur (1), delimited by the ossification zone (2) with thinning of the cortical layer (3)

    Systemic infiltration is observed in secondary metastatic tumors, neoplasms of the lymphoid and hematopoietic systems, histoiocytosis, lipid metabolism disorders.

    A characteristic feature of this type of infiltration is multiple polyosseous lesions.

    MRI images of systemic bone marrow infiltration are usually nonspecific and may not differ from normal distribution or reconversion of hematopoietic bone marrow.The exception is melanoma metastases, which have a high intensity on T1 WI due to the paramagnetic effects of melanin, as well as histiocytosis and lipid metabolism disorders that appear with low intensity on T1, T1-WI.

    The figure shows chronic myeloid leukemia. Diffuse infiltration of bone marrow in the metaepiphysis of the femur and tibia (1, 2)

    Benign neoplasms of soft tissues, as a rule, have clear contours, the neurovascular bundle does not grow and does not infiltrate bone structures.

    Popliteal synovial cysts are most common in clinical practice – cysts of the digastric-semimembranous bursa (Baker’s cysts).

    You can find out the cost of MRI diagnostics of joints here

    Ganglion ( synovial cyst, tendon-synovial cyst, when localized in the popliteal region – Becker’s cyst ; ICD-10: M67 Other lesions of the synovial membranes and tendons) cystic tissues, almost thin-walled lesions always associated with (but not associated with) the joint capsule, synovial sac or sheath of the tendon.The ganglion can be single-chambered or multi-chambered. It is more often localized on the back of the hands and feet, less often it is found on the palmar surface of the hand, the inner surface of the forearm, in the area of ​​the knee joint, etc. The multichamber ganglion has numerous lateral branches spreading among collagen fibers. It occurs at any age, somewhat more often in women. It develops as a result of the degeneration of collagen fibers. Intraosseous ganglion a disease in which a synovial cyst causes bone deformation by erosion of the cortical layer; usually subchondral localization near the joint.

    Clinical picture. Cystic weakly mobile formation, sometimes aching pains that increase with physical exertion. On palpation, it has a dense consistency, slightly painful or painless, sometimes fluctuates. There are no signs of inflammation in the surrounding tissues. The increase in the size of the ganglion is slow.

    Pathomorphology.

    Macroscopically, a cavity with a colorless viscous gelatinous liquid containing a large amount of mucin.

    Microscopy. Rounded tumor-like formation measuring from 0.5 to 5-6 cm in diameter. The wall of the cavity consists of a fibrous layer; the lining resembles the synovium, but is often absent.

    Differential diagnostics. Myxoma, fibrolipoma, epidermal and dermoid cysts.

    Treatment. Radical treatment consists of surgical complete excision of the ganglion.

    Outcome favorable.However, it may recur.

    90,000 Cases from blogs related to the spine

    This section describes the identification of diseases related to the spine. As practice shows, mri diagnostics of the spine in the early stages of the disease helps to significantly reduce the risk of developing diseases

    08 JAN
    MRI diagnosis of Schmorl’s cartilaginous nodes

    Patient G., 24 years old, turned to a neurologist at the medical center with complaints of back pain between the shoulder blades.The patient was referred for MRI of the thoracic spine at the CMR in order to clarify the diagnosis.

    MRI of the thoracic spine revealed: at the Th8-Th9 level in the adjacent endplates of the bodies of the same vertebrae, Schmorl’s cartilaginous nodes are determined.

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    DEC 27
    MRI diagnostics of posterior disc herniation C5-C6

    Patient R. 40 years old applied to the medical center to a neurologist with complaints of pain in the cervical spine. The patient was referred for MRI of the cervical spine at the CMR in order to clarify the diagnosis.

    MRI of the cervical spine revealed: At the C5-C6 level, under the small postero-lateral marginal bone growths, a posterior herniated disc up to 3 mm in size is determined.

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    26 NOV
    MRI diagnostics of posterior disc protrusion L5-S1

    Patient H., 25 years old, turned to a neurologist at the medical center with complaints of back pain. The patient was referred for MRI of the lumbosacral spine at the MRI in order to clarify the diagnosis.

    MRI of the lumbosacral spine revealed: MR signs of osteochondrosis at the L5-S1 level with the presence of diffuse disc protrusion up to 2.5 mm in size at this level.

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    23 NOV
    MRI diagnostics of herniated disc

    Patient E., 43 years old, consulted a neurologist at the medical center with complaints of pain in the neck with irradiation to the right arm. The patient was referred for MRI of the cervical spine at the CMR in order to clarify the diagnosis.

    MRI of the cervical spine at the level of C5-C6 revealed a right-sided postero-lateral herniated disc, up to 3.5 mm in size. Also, at the level of C4-C5, diffuse protrusion of the intervertebral disc up to 2 mm in size is determined.

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    14 NOV
    MRI diagnostics of chronic cerebrovascular insufficiency

    Patient X, 69 years old, consulted a neurologist at a medical center with complaints of headaches, periodic dizziness. In order to exclude focal brain lesions, the patient was referred for MRI.

    MRI of the brain revealed that in the white matter of both hemispheres, subcoritical and periventricular, multiple foci of a vascular nature are determined.Diagnosis: chronic cerebral circulation insufficiency.

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    07 NOV
    MRI diagnostics of a tumor of the frontal lobe

    We bring to your attention a clinical case of patient A., 66 years old, who, against the background of complete well-being, developed a generalized convulsive attack with loss of consciousness. The neurologist was referred for an MRI of the brain.

    On MRI scans of the right frontal lobe, an extensive area of ​​edematous changes (tumor tissue?) Is determined, which extends to the knee of the corpus callosum, the insular lobe, the anteromedial parts of the right temporal lobe, and the area of ​​the basal nuclei.

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    01 NOV
    MRI diagnostics of right-sided postero-lateral herniated disc

    Patient J., 40 years old, turned to a neurologist at the medical center with complaints of pain in the neck with irradiation to the right arm. The patient was referred for MRI of the cervical spine at the CMR in order to clarify the diagnosis.

    MRI of the cervical spine at the level of C6-C7 revealed a right-sided posterior-lateral herniated disc, up to 3.5 mm in size.

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    SEP 20
    MRI diagnostics of the spine after a fall

    Patient K.For 15 years, she turned to a neurologist at a medical center with complaints of pain in the thoracic spine after falling on her back. The patient was referred for MRI of the thoracic spine at the CMR in order to clarify the diagnosis.

    MRI of the thoracic spine revealed that the structure and shape of the vertebral bodies were not changed. Zones of pathologically altered MR signal in the vertebral bodies were not identified.

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    12 SEP
    MRI diagnostics of posterior protrusion of the disc L4-L5

    Patient N.At the age of 23 she turned to a neurologist at the medical center with complaints of back pain. The patient was referred for MRI of the lumbosacral spine at the MRI in order to clarify the diagnosis.

    MRI of the lumbosacral spine revealed: MR signs of osteochondrosis at the L4-L5 level with a diffuse protrusion of a 2.5 mm disc at this level.

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    10 SEP
    MRI diagnostics of posterior herniated discs

    Patient R., 76 years old, turned to a neurologist at the medical center with complaints of pain in the neck, headaches.The patient was referred for MRI of the cervical spine at the CMR in order to clarify the diagnosis.

    MRI of the cervical spine revealed: widespread osteochondrosis at the C2-C7 level with a sharp decrease in the height of the intervertebral discs, the presence of anterior and posterior-lateral marginal bone growths of the vertebral bodies, as well as posterior hernias of intervertebral discs at the C3-C7 level up to 3, 5 mm.

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    30 AUG
    MRI diagnostics of asymmetry of the calibers of the vertebral arteries

    A 43-year-old man turned to a neurologist with complaints of recurrent headaches, and therefore was referred for MR angiography of the cerebral vessels.

    On the obtained images of cerebral vessels in 3D-TOF mode, the asymmetry of the calibers of the vertebral arteries in the V4 segment is determined (the caliber of the PAD is less than the LA), which is most likely responsible for the clinical symptoms of the patient.

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    17 AUG
    MRI diagnostics of osteochondrosis

    Patient N., 39 years old, turned to a neurologist at the medical center with complaints of back pain. The patient was referred for MRI of the lumbosacral spine at the MRI in order to clarify the diagnosis.

    MRI of the lumbosacral spine revealed: MR signs of osteochondrosis at the L3-L4, L4-L5 levels with a 3 mm posterior disc herniation at the L4-L5 level.

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    10 AUG
    MRI diagnostics of posterior disc herniation L5-S1

    Patient R. 42 years old applied to the medical center to a neurologist with complaints of lower back pain radiating to the left buttock. The patient was referred for MRI of the lumbosacral spine at the MRI in order to clarify the diagnosis.

    MRI of the lumbosacral spine revealed: MR signs of osteochondrosis at the L4-L5, L5-S1 levels with a posterior (with slight lateralization to the left) disc herniation at the L4-L5 level, 3 mm in size.

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    JUL 31
    MRI diagnostics of posterior disc herniation L4 – L5

    Patient Sh. 40 years old applied to the medical center to a neurologist with complaints of lower back pain radiating to the left buttock. The patient was referred for MRI of the lumbosacral spine at the MRI in order to clarify the diagnosis.

    MRI of the lumbosacral spine revealed: MR signs of osteochondrosis at the level of L4-L5, L5-S1; posterior disc herniation at the level of L4-L5 up to 4 mm in size.

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    July 17
    MRI diagnostics of a hernia of the cervical spine at the level of C5-C6

    Patient K., 28 years old, turned to a neurologist at the medical center with complaints of pain in the cervical spine, poor sleep. The patient was referred for MRI of the cervical spine at the CMR in order to clarify the diagnosis.

    MRI of the cervical spine at the C5-C6 level revealed a posterior herniated disc.

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    15 JUL
    MRI diagnostics of a hernia of the cervical spine at the level of C6-C7

    Patient T., 38 years old, turned to a neurologist at the medical center with complaints of pain in the neck region radiating to the right and left arms. The patient was referred for MRI of the cervical spine at the CMR in order to clarify the diagnosis.

    MRI of the cervical spine at the C6-C7 level revealed a posterior herniated disc.

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    11 JAN
    MRI diagnostics of spondylolisthesis

    We bring to your attention a clinical case of patient K., 38 years old, who, after an injury 8 months ago (pressed against the door in the subway), began to notice weakness in her legs, occasionally cases of urinary incontinence. At the same time, low-intensity pain in the lumbar spine does not often bother. I performed MRI of the lumbar spine on my own.

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    20 DEC
    MRI diagnostics of sequestered hernia of the lumbar spine

    Patient M., 18 years after physical exertion and weight lifting, felt severe pain in the lumbar spine, spreading to the left leg. Referred by a neurologist for MRI of the lumbosacral region.

    On MRI scans, sequestered left-sided posterolateral disc herniation L5-S1 extending paramedianally, paraforamenally to the left up to 5 mm, caudally – up to 15 mm, compressing the left root.

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    07 DEC
    MRI diagnosis of spinal syringomyelia

    We bring to your attention a clinical case of patient M.30 years old, who for six months notes a decrease in strength and atrophy of the muscles of the right arm. The neuropathologist was referred for MRI of the cervical and thoracic spine.

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    28 NOV
    MRI diagnostics of a hernia of the cervical spine at the level of C4-C6

    We bring to your attention a clinical case of patient D, 40 years old, who has been worried about pain in the cervical spine for several years. In addition, notes frequent headaches, dizziness and numbness of the fingers. Under the direction of a neurologist, she performed MRI of the cervical spine.

    On MRI scans, the cervical lordosis is straightened with the formation of a small kyphotic deformity at the level of C4-C6 vertebrae.

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    22 NOV
    MRI diagnosis of stem stroke

    We bring to your attention a clinical case of patient T., 57 years old, who suddenly developed staggering gait. A neurologist directed for an MRI of the brain. History of nephrectomy (removal of the kidney) for cancer.

    MRI showed: against the background of signs of discirculatory encephalopathy in the anterior-basal parts of the left frontal lobe, a hematoma is determined, of a heterogeneous structure, surrounded by a small zone of edema.

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    20 NOV
    MRI diagnostics of hernia of the lumbar spine

    We would like to draw your attention to a clinical case of patient K, 45 years old, who has been suffering from pain in the lumbar region during physical exertion for 10 years. The pain radiates to the right leg. With the next exacerbation, she was treated at the place of residence for a month. Conservative treatment did not bring relief. For further examination and treatment, she was hospitalized in a hospital, where the patient underwent MRI of the lumbar spine.

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    19 NOV
    MRI diagnostics of sequestered herniated disc of the spine

    We bring to your attention a clinical case of patient E., 45 years old, who, while lifting weights in his summer cottage, developed a sharp pain in the lumbar spine, spreading to the right leg. Intense pain did not allow unbending. The patient was admitted to a hospital where he underwent an MRI of the lumbar spine.

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    11 OCT
    MRI diagnosis of hypoplasia of the left vertebral artery

    A 54-year-old man consulted a neurologist complaining of daily headaches in the afternoon, and therefore was referred for an MRI angiography of the cerebral vessels.

    On the obtained images of cerebral vessels in 3D-TOF mode, hypoplasia of the left vertebral artery in the V4 segment is determined, which most likely determines the clinical symptoms of the patient.

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    03 OCT
    MRI diagnosis of Arnold-Chiari I anomaly

    We bring to your attention a clinical case of a patient K., 15 years old, who came to see a neurologist with complaints of hand numbness. In addition, he noted periodic headaches in the occiput, aggravated by coughing and bending down.To clarify the nature of the changes, an MRI scan of the cervical spine was performed.

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    11 SEP
    MRI diagnosis of pancreatic tumor

    Patient H., 22 years old, consulted a gastroenterologist for recurrent dyspeptic disorders (nausea, belching). Ultrasound revealed a cystic formation of the pancreas. To clarify the nature of the changes and the prevalence of the process, it was directed to the MRI of the abdominal cavity

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    29 AUG
    MRI diagnostics of brainstem cavernoma

    We bring to your attention a clinical case of a 60-year-old patient K.There was facial asymmetry, impaired swallowing and speech. An ambulance team took the patient to the hospital, where an MRI was urgently performed.

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    20 AUG
    MRI diagnostics of the asymmetry of the vertebral arteries

    A 52-year-old man consulted a neurologist with complaints of daily headaches in the afternoon, and therefore was referred for an MRI angiography of the cerebral vessels.

    On the obtained images of cerebral vessels in 3D-TOF mode, the asymmetry of the calibers of the vertebral arteries in the V4 segment is determined (the caliber of the PAD is less than the LA), which is most likely responsible for the clinical symptoms of the patient.

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    07 AUG
    MRI diagnostics of a perineural cyst

    Patient L., 42 years old, turned to a neurologist at the medical center with complaints of lower back pain radiating to the right and left legs. The patient was referred for MRI of the lumbosacral spine at the CMR in order to clarify the diagnosis.

    MRI of the lumbosacral spine revealed: a large perineural cyst measuring 3.4×29 cm is determined in the spinal canal at the S2-S3 level.

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    03 AUG
    MRI diagnostics of sequestered disc herniation L5-S1

    Patient Sh.45 years old applied to the medical center to a neurologist with complaints of lower back pain radiating to the right leg. The patient was referred for MRI of the lumbosacral spine at the MRI in order to clarify the diagnosis.

    MRI of the lumbosacral spine revealed: at the L5-S1 level under the postero-lateral marginal bone growths, a posterior sequestered herniated disc is determined. The dimensions of the sequestration are 1.8×0.6 cm.

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    02 AUG
    MRI diagnosis of hypoplasia of the left vertebral artery

    A 54-year-old man consulted a neurologist complaining of daily headaches in the afternoon, and therefore was referred for an MRI angiography of the cerebral vessels.

    On the obtained images of cerebral vessels in 3D-TOF mode, hypoplasia of the left vertebral artery in the V4 segment is determined, which most likely determines the clinical symptoms of the patient.

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    23 JUL
    MRI diagnosis of Schmorl’s hernia in the thoracic spine

    Patient Sh. 35 years old applied to the medical center to a neurologist with complaints of pain in the lower thoracic spine. The patient was referred for MRI of the thoracic spine at the CMR in order to clarify the diagnosis.

    MRI of the thoracic spine revealed: multiple Schmorl’s cartilaginous nodes are determined in the adjacent endplates of the vertebral bodies in the Th9-Th22 vertebral bodies in the adjacent endplates of the vertebral bodies. The intensity of the MR signal from the vertebral bodies is not changed.

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    14 JUL
    MRI diagnosis of median hernia

    Patient J., 30 years old, turned to a neurologist at the medical center with complaints of a feeling of stiffness in the cervical spine, as well as pain. The patient was referred for MRI of the cervical spine at the CMR in order to clarify the diagnosis.

    MRI examination of the cervical spine revealed: At the C4-C5 level, under small postero-lateral marginal bone growths, a median herniated disc up to 3 mm in size is determined.

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    03 JUL
    MRI diagnostics of the thoracic spine after a fall

    Patient I., 36 years old, turned to a traumatologist at the medical center with complaints of back pain. From the anamnesis it is known that 3 days before going to the doctor, the patient fell on her back while snowboarding.In order to exclude the presence of bone-traumatic changes, she was sent for MRI of the thoracic spine.

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    28 JUNE
    MRI diagnostics of the lack of visualization of the right vertebral artery

    Patient P, 62 years old, was admitted to the Federal State Budgetary Institution “FTSSKE named after V.A. Almazov of the Ministry of Health and Social Development of the Russian Federation “for planned heart surgery. Before surgery, anesthesiologists recommended performing an MRI scan of the cerebral vessels in order to assess their condition before applying general anesthesia in order to avoid complications of ischemic origin.

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    27 JUN
    MRI diagnostics of cavernous hemangioma of the spinal cord

    We present to your attention a clinical case of patient P., 23 years old, who, against the background of complete well-being, developed numbness of the lower extremities. Within two weeks, lower paraparesis (paralysis of the lower limbs) developed. Hospitalized in a neurological clinic. To clarify the nature of pathological changes, MRI of the spine was performed.

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    18 JUN
    MRI diagnostics of metastatic bone lesions

    A clinical case of patient K.75 years old, who was diagnosed with prostate cancer (stage III). Two months ago, the patient began to worry about weakness in the legs, pain in the lumbar spine. Computed tomography of the lumbar spine was performed, signs of pronounced degenerative changes in the lumbar spine were revealed. With the diagnosis, osteochondrosis was treated by a neurologist at the place of residence, with little effect (lower back pain became less, but weakness in the legs remained). Two weeks ago, the weakness in the legs became significant, he stopped walking on his own.To clarify the diagnosis, an MRI scan of the lumbar spine was performed.

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    10 JUNE
    MRI diagnostics of a hernia of the cervical spine

    A 36-year-old female patient M. turned to a neurologist at the medical center with complaints of pain in the neck, poor sleep. The patient was referred for MRI of the cervical spine at the CMR in order to clarify the diagnosis.

    MRI of the cervical spine at the level of C5-C6, C6-C7 revealed posterior herniated discs.

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    23 MAY
    MRI diagnosis of spinal cord arteriovenous malformation

    A clinical case of patient B.40 years. A month ago, the patient began to complain of general weakness, chills, intense pain in the lower abdomen, complete immobility of the lower extremities. Symptoms of peritoneal irritation were added. For dynamic surgical observation, exclusion of acute paralytic intestinal obstruction, mesenteric thrombosis, according to urgent indications, he was hospitalized in a surgical hospital. To clarify the diagnosis, MRI of the lumbar spine was performed.

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    23 MAY
    MRI diagnosis of neuroma at the level of L4-L5 vertebrae

    We present to your attention a clinical case of patient A.44 years old. For six months, the patient has been disturbed by recurrent pain in the lumbar spine, in the left thigh, in the knee and ankle joints, and increasing weakness in the left foot. In order to clarify the diagnosis, she was referred by a neurologist for an MRI of the lumbar spine.

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    23 MAY
    MRI diagnostics of the formation of the spinal canal at the level of 7-8 thoracic vertebrae

    We present to your attention a clinical case of a patient T., 80 years old, who considers herself ill for seven years, when she began to notice pain and burning sensation in the lower extremities.She did not seek medical help. In recent months, there has been an increase in the described complaints, the appearance of pain in the lower thoracic spine, radiating to the left arm. I performed MRI on my own.

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    06 MAY
    MRI diagnostics of sacroiliitis

    A 12-year-old child with complaints of back pain underwent X-ray and subsequent MRI of the sacroiliac joints. On postcontrast images in T1 mode with a fat suppression program, a hyperintense MR signal is detected in the left sacroiliac joint along the slit of the sacroiliac joint against the background of unossified cartilage of the articulating surfaces.In addition, there are areas of hyperintense MR signal in the area of ​​the iliac cartilage and a site of trabecular edema of the ilium with a normal X-ray picture.

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    19 APR
    MRI diagnostics of herniated disc

    Patient K. A 43-year-old man came to an osteopath with complaints of back pain, sharply increasing with movement. Based on the examination results, the patient was diagnosed with a herniated disc at the L4-L5 level and surgical treatment was recommended.The patient decided to undergo another consultation with his district neurologist. The neurologist confirmed the diagnosis of a disc herniation, but recommended to undergo an MRI of the lumbosacral spine to resolve the issue of further treatment tactics.

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