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What does my MRI test report indicate?

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Posted on Mon, 23 May 2016
Question: Hello Dr. Tayal,

I contacted you with a hip issue a few weeks ago. You suggested that there could be nerve compression causing the appearance of muscle atrophy. I wanted to touch base with you again to thank you and to get your take on the direction my treatment is going (basically self-directed with medical guidance.
(I am determined to find the cause and not just manage the symptoms. After all, the were it not for the cause there would be no symptoms).

Since speaking with you, I have had an MRI arthrogram done for a suspected labral tear and gluteal tendopathy (none was found). I have been told by two orthopedic doctors they don't see anything that they can operate on. I'm assuming they are not looking further than the suspected labral tear. Additionally, research indicates that chronic tendon and muscle injuries may not have increased signal strength on imaging the same way that acute injuries do.

Additionally, I will have an EMG/Nerve Conduction study in a couple of weeks. This was my idea as a way to try to trace backward to discover the possible area on which to concentrate further musculoskeletal imaging.

I have taken some still shots of my MRI-A and put them into a single PDF document , which I have uploaded here. I am wondering if you could take a look and see if the areas where I have placed arrows look suspicious, of if you see anything in the overall view that you think warrants investigation. (Note: I was trying to see if I could visualize nerve entrapment, but I don't think these images are the right ones for that.)

Please take your time. I am in no real rush (I've lived with it this long) and accuracy is more important than speed. I am scheduled for nerve ablation on the R side low back tomorrow. I am holding off on the L side until after the EMG is completed.

I think I have a good team assembled - neuroscience doctor, physiatrist (physical medicine and rehabilitation doctor), and an awesome DPT. Blood work data for neuromuscular is back, but I have not met with the doctor (I highly doubt this is an issue). My team is missing an orthopedic doctor because I have not yet found one locally who is worth my time (yes, I did just say that intentionally).

I have done a ton of research (w-radiology.com; radiologyassistant.nl; and assorted white papers). I have also created a spreadsheet detailing a timeline, pain log (which I update regularly), and questions for doctors, and all of my local doctors have a copy. (Uploaded here for reference)

I am wondering if something on my imaging was skipped over because the radiologist and ortho-docs were looking ONLY for one thing - a labral tear. When that did not materialize, they did not look at other areas of the imaging.

Many thanks for your help,
XXXXX
doctor
Answered by Dr. Praveen Tayal (4 hours later)
Brief Answer:
Mild variation in muscle mass.

Detailed Answer:
Hello,
Thanks for posting your query.
I have seen the attached MRI images and detailed history. The MRI images do show a mild variation in the muscle fibers but this can be a normal variation. There is a slight thinning of the muscle mass but any specific tear or damage is not seen. Such slight variation cannot explain the symptoms that you have.
Maybe a nerve conduction test can help.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Praveen Tayal (3 hours later)
Thank you much for looking at my history and images. I greatly appreciate the opportunity for another set of eyes on the images and another thought process in the works.

I am hoping that the EMG will give another direction in which to look. Perhaps this whole thing is coming from my spine or SIJ.

The big question remains, what is in my history and symptoms that does not fit with the working hypothesis?

If you happen across anything that provides an ah-ha moment, I welcome your thoughts.

Many thanks,
XXXXX
doctor
Answered by Dr. Praveen Tayal (6 hours later)
Brief Answer:
Not due to a muscle deformity.

Detailed Answer:
Hello.
Thanks for writing again.
From the MRI scan, this does not seem to be a muscular deformity. It can be a nerve related issue. I will keep you updated in case anything new comes up my mind.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Praveen Tayal (10 hours later)
Thank you, your answer helps to narrow the search for a cause. Please feel free to reply again if you think of anything else. I am grateful for your time.

XXXX
doctor
Answered by Dr. Praveen Tayal (3 hours later)
Brief Answer:
You are most welcome.

Detailed Answer:
Hello.
Thank you.
I am happy I could help.
Please do recommend our services to others too in case you found them helpful. For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal
Wishing you the best in whatever you do.
Best regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Praveen Tayal (19 days later)
Greetings Dr. Tayal,

I'm going to try one more time. I'm attaching new images. Can you please take a look at them?

I think that my doctors here are looking at the wrong area(s) of the images... I think fail to notice other areas because they become focused on their singular area of expertise or because I have multiple areas of pain that may be interrelated. Also, some things may be overlooked because this is a chronic and/or repetitive stress issue, so the signal strength may not be as pronounced as with an acute injury. Also, I have dropped in a single x-ray image at the very end of the image set with a very specific question about it.

If you do not see anything, can you please recommend other imaging that may help the doctors diagnose the problem(s). Or perhaps I need to ask a radiologist?

I apologize in advance for the lengthy image file. You probably do not need all of them, but I thought that having them might help with orientation.

If you do see something, please let me know how I should communicate it to my doctors to help them see it.

I look forward to hearing from you.

Many thanks,
XXXX

P.S. I have recommended you to several other people. I appreciate your unbiased and very knowledgeable opinion.
doctor
Answered by Dr. Praveen Tayal (1 hour later)
Brief Answer:
No gross deformity detected.

Detailed Answer:
I have seen all the slides carefully. There is a slight decrease in the muscle mass on the left side but there is no gross structural deformity in the region. In the last slide, no fracture is visible. The nerves and bones do appear grossly normal.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Praveen Tayal (45 minutes later)
Okay. Thanks for looking.

I thought for sure that there was something on page 26 (slice 13). That round circle (yellow arrow) looks like an old (12+ months) hematoma.

The x-ray image question was based on a (newly attached) image I found on Radiology Assistant. I thought the diagonal line across the top edge (yellow arrow) looked like an old compression fracture.

**sigh**

I really thought these images fit my symptoms:
All Left side - (1) ASIS at TFL, ITB, inguinal ligament origin is excruciating to touch; swollen and warm after use or sitting a long time, pain radiates around trochanter area and diagonally down to groin. (2) Gluteal medius(?) Is very painful to pressure. (3) SIJ is a very sharp pain during movement.

Would you happen to have any suggestions for additional images or testing? I just had an EMG/NCV for low back nerve pain that was normal.

So frustrated and depressed. I don't think I can last much longer.
XXXX
doctor
Answered by Dr. Praveen Tayal (8 hours later)
Brief Answer:
Compression fracture not likely.

Detailed Answer:
I have seen the image of radiology assistant. But in your MRI scan there is no loss of vertical height and a minor cortical fracture is not likely. An old hematoma even it is present will not cause such a severe pain like you are having. To have pain relief, it is best to do a hot compress locally and take an oral muscle relaxant. If NCV and EMG testing has come normal then no further testing is needed.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Dr. Praveen Tayal

Orthopaedic Surgeon

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What does my MRI test report indicate?

Brief Answer: Mild variation in muscle mass. Detailed Answer: Hello, Thanks for posting your query. I have seen the attached MRI images and detailed history. The MRI images do show a mild variation in the muscle fibers but this can be a normal variation. There is a slight thinning of the muscle mass but any specific tear or damage is not seen. Such slight variation cannot explain the symptoms that you have. Maybe a nerve conduction test can help. I hope this answers your query. In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out. Wishing you good health. Regards. Dr. Praveen Tayal. For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal