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Suggest Treatment For Leg Pain
Question: 46 year old female
5"2 115 lbs
Otherwise healthy
Sept 2016
Leg Pain started as dull ache conevand go in tibia shinbone and sometimes sharp toward knee.
Shinbone feels bruised at times.
9/23/16 leg X-ray - normal
11:23/16 leg MRI without contrast showed proximal tibia stress changes without fracture and without a vascular necrosis
11/27/16 Ct scan of leg from knee to ankle was normal
1/3/17 another X-ray normal
I do not run or jog. I walk once in awhile but nothing strenuous.
1) what could the stress changes indicate?
2) Are stress changes in MRI the same as bone edema and pereosteal edema?
3) what role does that have to do with cancer?
4) would the abovevtests absolutely rule out cancer/ metastasis ?
Thank you
5"2 115 lbs
Otherwise healthy
Sept 2016
Leg Pain started as dull ache conevand go in tibia shinbone and sometimes sharp toward knee.
Shinbone feels bruised at times.
9/23/16 leg X-ray - normal
11:23/16 leg MRI without contrast showed proximal tibia stress changes without fracture and without a vascular necrosis
11/27/16 Ct scan of leg from knee to ankle was normal
1/3/17 another X-ray normal
I do not run or jog. I walk once in awhile but nothing strenuous.
1) what could the stress changes indicate?
2) Are stress changes in MRI the same as bone edema and pereosteal edema?
3) what role does that have to do with cancer?
4) would the abovevtests absolutely rule out cancer/ metastasis ?
Thank you
Brief Answer:
Answers to your questions
Detailed Answer:
Hi there
Thanks for the query
Stress changes indicate that your bone is trying to adjust to abnormal stress thus causing it to create some changes by increasing the hardness and possible remodelling in that region.
Bone oedema and Periosteal oedema indicate inflammatory reaction inside the bone and the outer Periosteal bone covering respectively. These do form a part of stress changes.
Bone cancer in the form of Osteosarcoma and Ewings sarcoma do present with thick Periosteal reaction but will also be associated with bone destruction and local signs of unusual bone structure damage with involvement of the surrounding soft tissue in most cases. In your case, there is no bone destruction nor any sort tissue involvement.
MRI does not show features of Bone cancer but isn't confirmatory. The best confirmation test is bone biopsy following which histopathological examination of the bone sample is done to look for cancer cells.
I hope I have answered your query.
I will be available to answer your follow up queries.
Regards,
Dr. Aashish Raghu
Answers to your questions
Detailed Answer:
Hi there
Thanks for the query
Stress changes indicate that your bone is trying to adjust to abnormal stress thus causing it to create some changes by increasing the hardness and possible remodelling in that region.
Bone oedema and Periosteal oedema indicate inflammatory reaction inside the bone and the outer Periosteal bone covering respectively. These do form a part of stress changes.
Bone cancer in the form of Osteosarcoma and Ewings sarcoma do present with thick Periosteal reaction but will also be associated with bone destruction and local signs of unusual bone structure damage with involvement of the surrounding soft tissue in most cases. In your case, there is no bone destruction nor any sort tissue involvement.
MRI does not show features of Bone cancer but isn't confirmatory. The best confirmation test is bone biopsy following which histopathological examination of the bone sample is done to look for cancer cells.
I hope I have answered your query.
I will be available to answer your follow up queries.
Regards,
Dr. Aashish Raghu
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you so much.
1) When you say MRI is bot confirmatory, is it bot reliable for bone cancer?
2) How confident /confirtable do you feel as Dr that MRI ct scan and xray would have shown a cancer orca metastisis?
3) If im not exercising strenuously, why is stress changes there?
4) How long after symptoms start IF it cancer that metastisis to the tibia would these tests pick up a tumor?
5) Could stress edema be early cancer?
XXXX
1) When you say MRI is bot confirmatory, is it bot reliable for bone cancer?
2) How confident /confirtable do you feel as Dr that MRI ct scan and xray would have shown a cancer orca metastisis?
3) If im not exercising strenuously, why is stress changes there?
4) How long after symptoms start IF it cancer that metastisis to the tibia would these tests pick up a tumor?
5) Could stress edema be early cancer?
XXXX
Brief Answer:
Answers
Detailed Answer:
Most early cancerous changes can be seen on an MRI, so it is quite sensitive ti pick up cancer.
I am comfortable as a Doctor to recommend MRI scan to look for early bone cancerous changes or metastasis in my patients.
Non-streneous but repetitive loading movements like even walking, marching, jogging can cause stress fractures by the sheer reason of constant or regular exposure to the stress.
Usually when the symptoms have started, the MRI will almost always be able to pick up the cancer or metastasis to the tibia at that time.
Stress oedema is only localised inflammation and isn't specific to stress or tumour. But tumour shows bone formation or destruction. They both are very different.
Answers
Detailed Answer:
Most early cancerous changes can be seen on an MRI, so it is quite sensitive ti pick up cancer.
I am comfortable as a Doctor to recommend MRI scan to look for early bone cancerous changes or metastasis in my patients.
Non-streneous but repetitive loading movements like even walking, marching, jogging can cause stress fractures by the sheer reason of constant or regular exposure to the stress.
Usually when the symptoms have started, the MRI will almost always be able to pick up the cancer or metastasis to the tibia at that time.
Stress oedema is only localised inflammation and isn't specific to stress or tumour. But tumour shows bone formation or destruction. They both are very different.
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you. I appreciate your detailed responses.
So what would my diagnoses be?
Seems strange tye pain is not going away. It doesnt hurt all day. When i go up stairs or move a certain way mostly .
So what would my diagnoses be?
Seems strange tye pain is not going away. It doesnt hurt all day. When i go up stairs or move a certain way mostly .
Brief Answer:
DEXA Scan
Detailed Answer:
Give the limb rest. Keep it elevated. Apply warm packs to the affected region. Avoid weight bearing for 10 days. Cos just tip toe weight bearing for now. Take Tablet Ibuprofen 400mg twice a day after meals and Tablet Rabeprazole twice a day for 5 days before meals.
The stress fracture changed need to heal. So hey a DEXA scam of your vertebra and hip soon, to help find out if you have weak osteoporotic bonesm
DEXA Scan
Detailed Answer:
Give the limb rest. Keep it elevated. Apply warm packs to the affected region. Avoid weight bearing for 10 days. Cos just tip toe weight bearing for now. Take Tablet Ibuprofen 400mg twice a day after meals and Tablet Rabeprazole twice a day for 5 days before meals.
The stress fracture changed need to heal. So hey a DEXA scam of your vertebra and hip soon, to help find out if you have weak osteoporotic bonesm
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Thank you.
I did a dexa scan and it was normal. Bo probkems at all.
I have been very gentle, resting the leg but its been about 10 weeks.
It is very strange .
I did a dexa scan and it was normal. Bo probkems at all.
I have been very gentle, resting the leg but its been about 10 weeks.
It is very strange .
Brief Answer:
Ankle pumps and quads strengthening
Detailed Answer:
Thank you for your reply.
Do ankle pump, quadriceps muscle strengthening exercises to reduce the oedema and recover faster.
Ankle pumps and quads strengthening
Detailed Answer:
Thank you for your reply.
Do ankle pump, quadriceps muscle strengthening exercises to reduce the oedema and recover faster.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
Thank you i appreciate your help.
Stay well
Stay well
Brief Answer:
Get well soon
Detailed Answer:
Good luck! Get well soon
Do follow up with me on your progress
Get well soon
Detailed Answer:
Good luck! Get well soon
Do follow up with me on your progress
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Nagamani Ng
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