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60 Years Old. Having Pain In Shoulder Joint And Feeling Difficulty To Walk. Looking For Treatment?
Question: Dear Sir,
My mother aged around 60 yrs find it difficult to walk. feels pain in the waist while sitting for more than 10-15 minutes.cant squat on the ground more over she also have a pain in left shoulder joint.while walking with support , after walking for few steps she bends forward and feel like she will fell on the ground in addition to that while standing it appears that she is slightly bending towards left.She laso feels haeviness in left leg and feels like it is jammed
you are requested to advise me REGARDING TREATMENT OPTION.
My mother got her MRI LS SPine done on 17/0/2012. following is the report copy
DEPARTMENT OF RADIOLOGYUHID: FHL.0000Age/Sex :55 Year(s)/FOrder Date:12-Jul-2012Name: Mrs. XXXXXXX Order No.: OP0000Con.Doctor: UJJWAL DEBNATHReport Date:17-Jul-2012MRI STANDARDMRI L.S.SPINEPROTOCOLT2 screening of whole spine sagittalAxial - TI, T2.Sagittal - Tl, T2, STIR Coronas - T2Myelo - Sagittal,CoronalThe study shows early degeneration of all lumbar intervertebral discs.Small prolapse is seen in all the lumbar intervertebral discs, posterocentrally,seen indenting the thecal sac at therespective levels, slightly more at L5-S 1 level.Small right posterolateral annular tear is seen in L5-Sl intervertebral disc.Arthropathic right facetal joint is seen at L5-S 1 level.Otherwise rest of the facet joints are normal.Vertebral bodies show normal height, contour and signal characteristics.I he lateral recesses and neural foramina are normal.Spinal canal is normal.Visualised cord, conus and cauda equina are normal in thickness and shows normal signal. Pre- and para-spinal soft tissues are normal.Regd. Office: Escorts Heart Institute and Research Cei itre, Okhla Road, New Delhi-1 0000.
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Fortis Hospitals Limited0730, Anandapur, EM Bypass Road.It Fortis Kolkata - 0000, India.Tel : -9133 6628 4444HOSPITALSFax: +91-33-6628 4242.www.f o tishospitals. in DEPARTMENT OF RADIOLOGYUHID: FHL.0000Age/Sex : 55 Year(s)/F Order Date:12-Jul-2012Name: Mrs. XXXXXXX Order No.: OP0000 ICon.Doctor: UJJWAL DEBNATHReport Date:17-Jul-2012AP Diameters (in cm) of lumbar spinal canal at various levels are as follows:D 12-L l - 1.49LI-1.40LI-L2-0.96L2- 1.05L2-L3-1.03L3-1.24L3-L4-1.04L4- 1.11L4-L5-1.01L5-1.2L5-S1-1.11IMPRESSION :- Early degeneration of all the lumbar intervertebral discs.- Small posterocentral type of prolapse in all the lumbar intervertebral discs, slightly more at L5-S1 level.- Small right posterocentral type of annular tear seen in L5-S l intervertebral disc.- Arthropathic right facetal joint at L5-S1 level.
My mother aged around 60 yrs find it difficult to walk. feels pain in the waist while sitting for more than 10-15 minutes.cant squat on the ground more over she also have a pain in left shoulder joint.while walking with support , after walking for few steps she bends forward and feel like she will fell on the ground in addition to that while standing it appears that she is slightly bending towards left.She laso feels haeviness in left leg and feels like it is jammed
you are requested to advise me REGARDING TREATMENT OPTION.
My mother got her MRI LS SPine done on 17/0/2012. following is the report copy
DEPARTMENT OF RADIOLOGYUHID: FHL.0000Age/Sex :55 Year(s)/FOrder Date:12-Jul-2012Name: Mrs. XXXXXXX Order No.: OP0000Con.Doctor: UJJWAL DEBNATHReport Date:17-Jul-2012MRI STANDARDMRI L.S.SPINEPROTOCOLT2 screening of whole spine sagittalAxial - TI, T2.Sagittal - Tl, T2, STIR Coronas - T2Myelo - Sagittal,CoronalThe study shows early degeneration of all lumbar intervertebral discs.Small prolapse is seen in all the lumbar intervertebral discs, posterocentrally,seen indenting the thecal sac at therespective levels, slightly more at L5-S 1 level.Small right posterolateral annular tear is seen in L5-Sl intervertebral disc.Arthropathic right facetal joint is seen at L5-S 1 level.Otherwise rest of the facet joints are normal.Vertebral bodies show normal height, contour and signal characteristics.I he lateral recesses and neural foramina are normal.Spinal canal is normal.Visualised cord, conus and cauda equina are normal in thickness and shows normal signal. Pre- and para-spinal soft tissues are normal.Regd. Office: Escorts Heart Institute and Research Cei itre, Okhla Road, New Delhi-1 0000.
--------------------------------------------------------------------------------
Fortis Hospitals Limited0730, Anandapur, EM Bypass Road.It Fortis Kolkata - 0000, India.Tel : -9133 6628 4444HOSPITALSFax: +91-33-6628 4242.www.f o tishospitals. in DEPARTMENT OF RADIOLOGYUHID: FHL.0000Age/Sex : 55 Year(s)/F Order Date:12-Jul-2012Name: Mrs. XXXXXXX Order No.: OP0000 ICon.Doctor: UJJWAL DEBNATHReport Date:17-Jul-2012AP Diameters (in cm) of lumbar spinal canal at various levels are as follows:D 12-L l - 1.49LI-1.40LI-L2-0.96L2- 1.05L2-L3-1.03L3-1.24L3-L4-1.04L4- 1.11L4-L5-1.01L5-1.2L5-S1-1.11IMPRESSION :- Early degeneration of all the lumbar intervertebral discs.- Small posterocentral type of prolapse in all the lumbar intervertebral discs, slightly more at L5-S1 level.- Small right posterocentral type of annular tear seen in L5-S l intervertebral disc.- Arthropathic right facetal joint at L5-S1 level.
Hi.
Thanks for the query.
I understand your mother's situation. Few reasons, which can cause back pain, are disc prolapse (annular tear), nerve root irritation or facetal arthropathy.
Nerve root irritation usually gives pain in back as well as buttocks or legs. MRI report does not show any nerve root compression but it indicates facet arthropathy.
I would like to know more about the pain pattern. Location? any radiation? tingling? aggravating or relieving factors? any night pain? does she get good sleep in the night? How about Straight leg raising? do you have any reports about physical exam of the patient? Is she able to do toe walking or heel walking? any changes in the symptoms or any new complaints after this MRI?
Is it possible to upload the MRI pictures? Right now, I would suggest continuing rest with anti-inflammatory with muscle relaxants and physiotherapy modalities. I really like to establish the correlation between the MRI and clinical symptoms of the patient before suggesting any intervention.
Please get back to me with above information so that I will be in a better position to tell you about the pain generator.
Thanks.
Thanks for the query.
I understand your mother's situation. Few reasons, which can cause back pain, are disc prolapse (annular tear), nerve root irritation or facetal arthropathy.
Nerve root irritation usually gives pain in back as well as buttocks or legs. MRI report does not show any nerve root compression but it indicates facet arthropathy.
I would like to know more about the pain pattern. Location? any radiation? tingling? aggravating or relieving factors? any night pain? does she get good sleep in the night? How about Straight leg raising? do you have any reports about physical exam of the patient? Is she able to do toe walking or heel walking? any changes in the symptoms or any new complaints after this MRI?
Is it possible to upload the MRI pictures? Right now, I would suggest continuing rest with anti-inflammatory with muscle relaxants and physiotherapy modalities. I really like to establish the correlation between the MRI and clinical symptoms of the patient before suggesting any intervention.
Please get back to me with above information so that I will be in a better position to tell you about the pain generator.
Thanks.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Thanks for your quick respone. sir right now i dont have MRI film in soft copy.
however desired info asked by you is follow.
pain is in the entire waist area. it is ok when she is resting on the bed or sitting for 10-15 minutes. she feel pain when she starts to walk for few steps with support( she can toe/heel walk or walk woithout support). there is no radiation/shifting in the pain it is almost same the entire day . have good sleep at night.
after the MRI in july she is feeling more pain (bearable) in the left shoulder joint sometimes tingling and she cant touch her back with left hand.
she do feel tingling sometimes in sole.(talwa)
the main concern is that she cant walk on her own and even with support of side walls a few steps . her geight is 5 fit 4 inch and weght 70 kg.. it is to be noted that, currently she is not on allopathic medication. if possible kindly suggest some medicine or alternative therapy if surgery is option or otherwise.
however desired info asked by you is follow.
pain is in the entire waist area. it is ok when she is resting on the bed or sitting for 10-15 minutes. she feel pain when she starts to walk for few steps with support( she can toe/heel walk or walk woithout support). there is no radiation/shifting in the pain it is almost same the entire day . have good sleep at night.
after the MRI in july she is feeling more pain (bearable) in the left shoulder joint sometimes tingling and she cant touch her back with left hand.
she do feel tingling sometimes in sole.(talwa)
the main concern is that she cant walk on her own and even with support of side walls a few steps . her geight is 5 fit 4 inch and weght 70 kg.. it is to be noted that, currently she is not on allopathic medication. if possible kindly suggest some medicine or alternative therapy if surgery is option or otherwise.
Thanks for the information.
There are three main complaints we are dealing with- shoulder pain, waist pain and leg numbness heaviness. It looks like she may have frozen shoulder, which makes that joint stiff, and medicine with physiotherapy usually helps.
Coming to waist pain, this could be due to disc prolapse or facetal arthropathy or both. These are two different entities. However, I am just curious to know if she is diabetic as both things could happen in diabetic. Coming to leg numbness, which is usually due to nerve compression however MRI did not indicate that and if this problem is persistent and bothering all the time then I would suggest to get EMG/NCV studies.
Other thing her ESR is 81 which is concerning. How about other body work ups? Any other significant medical problem?
Right now for pain relief she can take analgesics like etodolac, thiocholchiside and pregabalin and physio modalities like ultrasound or IFT. These are prescription drugs; please get them prescribed by her doctor.
I hope this helps you.
Regards,
There are three main complaints we are dealing with- shoulder pain, waist pain and leg numbness heaviness. It looks like she may have frozen shoulder, which makes that joint stiff, and medicine with physiotherapy usually helps.
Coming to waist pain, this could be due to disc prolapse or facetal arthropathy or both. These are two different entities. However, I am just curious to know if she is diabetic as both things could happen in diabetic. Coming to leg numbness, which is usually due to nerve compression however MRI did not indicate that and if this problem is persistent and bothering all the time then I would suggest to get EMG/NCV studies.
Other thing her ESR is 81 which is concerning. How about other body work ups? Any other significant medical problem?
Right now for pain relief she can take analgesics like etodolac, thiocholchiside and pregabalin and physio modalities like ultrasound or IFT. These are prescription drugs; please get them prescribed by her doctor.
I hope this helps you.
Regards,
Above answer was peer-reviewed by :
Dr. Shanthi.E
Thank You,
Got your points,
sir, one Spine specialist told us that she has to be operated for L5/S1 decompression or reconstruction. i wish to know your opinion and if this is the option then guide me where to get it done how much will be approximate cost in india.
With Regards,
XXXXXXX XXXXXXX
Got your points,
sir, one Spine specialist told us that she has to be operated for L5/S1 decompression or reconstruction. i wish to know your opinion and if this is the option then guide me where to get it done how much will be approximate cost in india.
With Regards,
XXXXXXX XXXXXXX
Hi XXXXXXX
I really need to see the MRI images to opine about surgical option. However if she has already tried medicine and physiotherapy modalities with no relief then I would consider doing spinal fusion surgery.
In Spine surgery, decompression surgery is indicated to free the nerve roots and spinal fusion surgery is indicated if patient having significant back pain. In her case, if I choose to operate then I will try to treat both problems leg and waist pain. I will consider doing instrumented L5-S1 fusion with intervertebral spacer after removing the disc. It will remove all possible pain generators such as facet arthropathy and annular tear and along with that decompression of the nerve roots.
If you consider doing this procedure in Pune, India then it would cost around Rs 2 lakhs.
Thanks.
I really need to see the MRI images to opine about surgical option. However if she has already tried medicine and physiotherapy modalities with no relief then I would consider doing spinal fusion surgery.
In Spine surgery, decompression surgery is indicated to free the nerve roots and spinal fusion surgery is indicated if patient having significant back pain. In her case, if I choose to operate then I will try to treat both problems leg and waist pain. I will consider doing instrumented L5-S1 fusion with intervertebral spacer after removing the disc. It will remove all possible pain generators such as facet arthropathy and annular tear and along with that decompression of the nerve roots.
If you consider doing this procedure in Pune, India then it would cost around Rs 2 lakhs.
Thanks.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Dear Sir,
can you suggest some good spine surgery hospital in kolkata/Delhi.
Regards,
XXXXXXX XXXXXXX
can you suggest some good spine surgery hospital in kolkata/Delhi.
Regards,
XXXXXXX XXXXXXX
I am sorry; I do not have any personal reference of doctors practising in Delhi as I practice at a different location. I heard about XXXXXXX Specialty hospital in Delhi. You may contact them.
Hope this helps.
If all your queries are answered, please close this discussion.
Regards
Hope this helps.
If all your queries are answered, please close this discussion.
Regards
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Prasad
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