[madman]

My wife recently had an MRI scan on 28th November 08 as a result of a car accident she was involved in back in January 2008.

We have received results of the Scan with a brief report and was hoping someone may be able to help put it into layman's terms for me.

It reads as follows.


In the cervical region, sagittal and axial T1 and T2 weighted images have been obtained. The cervical intervertebral discs are generally within normal limits though there is a suggestion of some early disc space narrowing at C5/6.

Axial views show no significant disc herniation, cord encroachment or intrinsic cord signal change, and the exit foramina appear well preserved with no evidence of nerve root encroachment.

The craniovertevral junction and upper dorsal regions appear normal and parasagittal views show that the facet joints are in normal alignment.

In the right shoulder, sagittal axial and coronal T1, T2 and fat suppression images have been obtained.

There is some modest soft tissue thickening and signal increase at the ACJ, and there appears to be some fluid in the subacromial bursa suggesting some modest bursitis here. The acromion slopes somewhat inferiorly but there does not appear to be significant supraspinatus tendinopathy and the other components of the rotator cuff appear in tact. The glenohumeral joing and the labrum appear unremarkable and the long head of biceps tendon is in normal position.

CONCLUSION

No major cervical disc herniation or neutral compression is seen though there may be some early degenerative change at the C5/6 intravertebral disc.

There is some modest inflammatory change at the right ACJ with the impression of some subacromial bursitis but no major rotator cuff tear is identified.


Any help would be appreciated.

Thanks in advance.

[madman]

Is there a doctor in the house?

[xraymd]

Oh, I'm on.

Overall, doesn't sound too bad. Doesn't sound like any recent trauma. Sounds like some early arthritis in her lower neck at C5-6. This is almost always the first level to have arthritis and just about everyone over 40 will have some early change here.

Same thing in the shoulder. Doesn't sound like any fracture or rotator cuff disease. There is some early arthritis in the AC joint which is between the collar bone and the shoulder blade. Put your left fingers on top of your right shoulder and you're touching the AC joint (acromio-clavicular). There's a normal cushion of fluid between the rotator cuff and the bone at the top of the shoulder. Sounds like she has a little more fluid here than normal which suggests it's inflamed (bursitis). This often doesn't look too impressive on the MRI but can certainly hurt.

Bottom line - some early changes related to aging but nothing too severe.

[TiAg335i]

You are too funny man. Go back to the doctor and have him interpret this for you instead of asking a bunch of car guys.

[xraymd]

It's already been interpreted. That's what the report is. His wife's doctor will look at the radiologist's report and try to explain it the way I did.

I don't know about Britain, but in the US, primary care docs rarely look at the MRI directly. Specialists like orthopedics or neurosurgery usually do look at the pictures.

[madman]

Originally Posted by xraymd

Oh, I'm on.

Overall, doesn't sound too bad. Doesn't sound like any recent trauma. Sounds like some early arthritis in her lower neck at C5-6. This is almost always the first level to have arthritis and just about everyone over 40 will have some early change here.

Same thing in the shoulder. Doesn't sound like any fracture or rotator cuff disease. There is some early arthritis in the AC joint which is between the collar bone and the shoulder blade. Put your left fingers on top of your right shoulder and you're touching the AC joint (acromio-clavicular). There's a normal cushion of fluid between the rotator cuff and the bone at the top of the shoulder. Sounds like she has a little more fluid here than normal which suggests it's inflamed (bursitis). This often doesn't look too impressive on the MRI but can certainly hurt.

Bottom line - some early changes related to aging but nothing too severe.

Thanks for the info, but my wife is only 26....I imagine this may change your reply?

[madman]

Originally Posted by TiAg335i

You are too funny man. Go back to the doctor and have him interpret this for you instead of asking a bunch of car guys.

She will. But the appointment isnt for another two weeks.

[schadenfreude]

Originally Posted by madman

Thanks for the info, but my wife is only 26....I imagine this may change your reply?

I've seen younger people with worse MRI results...

[xraymd]

Oh that changes everything. Not the diagnosis, just what you can tell your wife I once mentioned "early age related changes" on an MRI brain I read on a friend who's an orthopedic (orthopaedic across the pond) surgeon. He called me up and said "that was the meanest thing anybody has ever said about me."

MRI is so sensitive it can pick up early degenerative changes even in somebody in their 20's. That said, there are certainly some radiologists who are so used to calling disc space narrowing at C5-6 that they call it on just about everybody. Either way, early degeneration at C5-6 or in the AC joint isn't too concerning. It will happen to all of us eventually. I bet it's the bursitis at the shoulder that's the real trouble.

[madman]

Do you think this would affect her work.

She is a dog groomer and has just set up a business doing it. It is something she has been wanting to do since being a child and she's be devastated if it could cause problems with that?

[eleven11]

I agree with Xray. The bottom line that you should care about is the management. Nothing noted in the read indicates anything that should be done outside of needed medication or mild physical therapy (e.g. pain meds, anti-inflammatories, stretching, massage). In other words, from the read alone (i.e. lacking physical examination), no surgical intervention is necessary. Again, let her doc combine this read with her exam to make any other decisions. Pain and/or range-of-motion, etc. may take a little time to pass - if it persists beyond what's expected, then you begin to consider the orthopedic referral (aspiration, steroid injection, surgery). At that point (if it even ever gets to that), it's a, 'how bad does this bother you vs. how bad do you want invasive treatment' thing.

[osteome]

Originally Posted by eleven11

I agree with Xray. The bottom line that you should care about is the management. Nothing noted in the read indicates anything that should be done outside of needed medication or mild physical therapy (e.g. pain meds, anti-inflammatories, stretching, massage). In other words, from the read alone (i.e. lacking physical examination), no surgical intervention is necessary. Again, let her doc combine this read with her exam to make any other decisions. Pain and/or range-of-motion, etc. may take a little time to pass - if it persists beyond what's expected, then you begin to consider the orthopedic referral (aspiration, steroid injection, surgery). At that point (if it even ever gets to that), it's a, 'how bad does this bother you vs. how bad do you want invasive treatment' thing.

I concur.

[J BONE]

Originally Posted by osteome

I concur.

+2 If it gets any worse, see Ortho for possible subacromial injection. Other than that, nothing to get really worried about.