Management of ailments may differ in Branches of medicines. But investigations common for all

1. Ideal diagnostics
Overview

2. Today ours focus is
 1] What investigations to do ?
 2] How to Write test ? View …
 3] How to Read the Reports & Images ?
 4] What to do Next ? Follow-up tests needed or not
 6] How to approach Neck & Shoulder Pain; Low
Backpain & Leg Swellings

3. Ideal diagnostics
Importance of Diagnosis
 Is investigations necessary ?
 Only Clinical Evaluation
= Management
Is it Possible ?

4. Ideal diagnostics
TEAM EFFORT
{Diagnostician & Therapeutician}
CONFIRMATORY DIAGNOSIS
{ INVESTIGATIONS}
TREATMENT
MANAGEMENT
CLINICAL DIAGNOSIS
{ PROVISIONAL DIAGNOSIS}

5. NATUROPATHY
UNANI
AYURVEDA
&
SIDDHA
HOMEO
ALLOPATHY
FINALFINAL
DIAGNOSISDIAGNOSIS
Ideal diagnostics

6. Ideal diagnostics
Importance of Confirmatory Diagnosis
 To Choose / Plan Appropriate method of
Management
 To initiate Early Treatment
 To avoid late Complications
 For Medico-legal Overcome
 For Future Follow-up

7. Ideal diagnostics
Investigations
 Radiology
 Non-Radiological
 Lab Tests / Pathology - For all Systems
 Cardiac – ECG / Treadmill/ ECHO/ ANGIO
 Neuro- EEG/ ENMG
 Audiogram - ENT
 Bone densitometer- BONE
 Spirometry – Lung Capacity
 Endoscopy – Any Luminal Structure

8. Chocolate Cyst Ovary
TB LUNGS
Meningioma

9. Shoulder Pain
Ideal diagnostics

10. Ideal diagnostics
What Causes Shoulder Pain?
The shoulder is a ball and socket joint with a
large range of movement. Such a mobile joint
tends to be more susceptible to injury. Shoulder
pain can stem from one or more of the following
causes:
1.Strains from overexertion
2.Tendonitis from overuse
3.Shoulder joint instability
4.Dislocation
5.Collar or upper arm bone fractures
6.Frozen shoulder
7. Pinched nerves (also called radiculopathy)

11. Shoulder Anatomy
Ideal diagnostics

12. Case Scenario : 1
 40 yrs old male with acute onset of Pain Rt
shoulder with restricted movements… Few
months
Could it be fracture ? Muscle tear ??
First to R/O Serious one fracture..
Advice …
X-Ray Rt Shoulder ..Which view
AP View…

13. X-Ray Shoulder AP View
 Look for Bony Parts
 Joint Space
 Dislocation
 Fracture
Normal … What next

14. ULTRASOUND RT SHOULDER
 Muscular / Tendinous
Tear { Complete /
Partial}
 Tendinitis
 Joint Effusion
 Soft tissue swelling

15. MRI SCAN SHOULDER
 Confirmation of earlier
findings
 Articular Cartilage /
Ligamentous injury
 Soft tissue details
 Gold Standard for non
bony lesions

16. Ideal diagnostics
X-Ray Shoulder

17. 1. AP VIEW
2. LATERAL VIEW
3. AXILLARY VIEW
X- Ray Shoulder Views
Ideal diagnostics

18.  COMMON SHOULDER PATHOLOGIES:
1. Fracture
2. Dislocations - Anterior / Posterior / inferior
3. Arthritis - Osteoarthritis / others
4. Rotator Cuff Pathologies
Ideal diagnostics

19. Fracture
Ideal diagnostics

20. Dislocations
Ideal diagnostics

21. Gleno-humeral OA

22. Acromio-Clavicular OA
Ideal diagnostics

23. Tendinitis in X-Ray
Ideal diagnostics

24. Ultrasound Shoulder
Ideal diagnostics

25. Neck Pain
Prevalence of Neck Pain in the General
Population is about 15 %
Shoulder Problems can masquerade as
Cervical Problems & Vice versa
Ideal diagnostics

26. Ideal diagnostics
What Causes Neck Pain?
•Abnormalities in the bone or joints
•Trauma
•Poor posture
•Degenerative diseases
•Tumors
•Muscle strain

27. Parts of Cervical Spine
Ideal diagnostics

28. Ideal diagnostics
Normal Cervical Spine
Short Neck Long Neck

29. Ideal diagnostics
Cervical Spine
 Typical Vertebrae- Body ; Pedicle;
[Vertebral foramen +] Neural arch
& Spinous Process
. Atypical Vertebrae- 1. Atlas
2. Axis
3. Long Spinous
Process C 7

30. Ideal diagnostics
Parts of Vertebra
 Body
 Endplates
 Pedicles
 Lamina
 Transverse Process
 Spinous Process

31. Ideal diagnostics
Spinal Internal Joints
 Facet Joints
 Disco-vertebral joints

32. Types of Arthritis
Ideal diagnostics

33. DISH { Diffuse idiopathic Skeletal Hyperostosis}
Ideal diagnostics

34. CERVICAL RIB
Ideal diagnostics

35. Rheumatoid Arthritis
Atlanto-axial Dislocation
Ideal diagnostics

36. Cervical Spondylosis
Ideal diagnostics
1. Cervical Spondylosis is a general & nonspecific term that
encompasses a broad spectrum of afflictions
2. Develops either Spontaneously with age or Secondary as
the result of trauma or Pathological Conditions
3. With age loss of water in the disc – loss of absorber effect- secondary
changes in facet joints & ligaments – Regeneration { Spur}
4. 3 Phases : [a] Dysfunction – [b] Instability – [c] Stabilization
5. “Soft Disc” herniation- Displaced nucleus Pulposes
“Hard Disc” herniation – Posterior marginal osteophytes

37. Cervical Spondylosis
6. By age 60 – 65 , 95% male & 70% female
nonsymptomatic show atleast 1 degenerative
sign in the spine
7. Two most common sites C 5-6 disc { C6
root- Biceps} & C 6-7 disc { C7 root- Triceps}
Ideal diagnostics

38. Cervical Spondylosis
Ideal diagnostics
Cervical to Coccyx
Spinal Curvatures :
Lordosis
Scoliosis

39. Cervical Spondylosis
Ideal diagnostics

40. Cervical Spondylosis
Ideal diagnostics

41. Low Back ache
Ideal diagnostics

42. Low Back Pain
 54 yrs old female presented with low
backpain for 1 year duration. Constant,
dull ache more focussed on either side of
Spine?
 Reason?
 Renal stone ? Gynec ? GB /Pancreas?
Spinal ?
Ideal diagnostics

43. Backache - ? Spinal
Ideal diagnostics

44. Ideal diagnostics

45. Lumbar Spine Pathologies
 Degenerative
Spondylolysis
Spondylolisthesis
Facet Joint Hypertrophy
 Ankylosing Spondylitis
 Spinal Canal Stenosis
 Osteomyelitis { Koch’s – Pott’s spine }
 Neoplastic { Multiple Myeloma / Mets}
Ideal diagnostics

46. Ideal diagnostics
Back Pain Culprit:
Chronic Conditions
Several chronic conditions can lead to low back
pain.
Spinal stenosis is a narrowing of the space
around the spinal cord, which can put pressure on
the spinal nerves.
Spondylitis refers to chronic back pain and
stiffness due to severe inflammation of the spinal
joints.
Fibromyalgia causes widespread muscle aches,
including back pain.

47. Lumbar Spondylosis {DDD}
Ideal diagnostics

48. Parts of a DISC
Ideal diagnostics

49. Ideal diagnostics
Back Pain Culprit: Herniated Disc
The spine's vertebrae are cushioned by gel-like discs
that are prone to wear and tear from aging or
injuries. A weakened disc may rupture or bulge,
putting pressure on the spinal nerve roots. This is
known as a herniated disc and can cause intense
pain.

50. DISC PROLAPSE
Ideal diagnostics

51. Ideal diagnostics
Lumbar Spondylosis
Narrow Disc Space Marginal Osteophytes

52. Spondylolysis
Ideal diagnostics

53. Ideal diagnostics
Spondylolysis is a condition in which
the there is a defect in a portion of the
spine called thepars interarticularis (a
small segment of bone joining the facet
joints in the back of the spine).
With the condition of spondylolisthesis,
the pars interarticularis defect can be on
one side of the spine only (unilateral) or
both sides (bilateral).
The most common level it is found is at
L5-S1, although spondylolisthesis can
occur at L4-5 and rarely at a higher
level.

54. Spondylosis
Ideal diagnostics

55. Ideal diagnostics
Spondylolisthesis is a condition in
which one vertebra slips forward over the
one below it.
The most common symptoms are lower
back pain and/or leg pain that limits
activity level.

56. Spondylolisthesis
Ideal diagnostics

57. Spondylolisthesis
Ideal diagnostics

58. spondyloarthritis
Ideal diagnostics

59. Ankylosing Spondylitis
Ideal diagnostics

60. Pedicle metastases
Ideal diagnostics

61. Spine Neoplasm { MM / Prostate}
Ideal diagnostics

62. TB Spine { Koch’s / Pott’s spine}
Ideal diagnostics

63. Ideal diagnostics
osteopenia
 Senility
 Vit.D Deficiency
 Hypo-parathyroidism
 Hypocalcemia &
Hypophosphatasia

64. HYPEROSTOSIS
Ideal diagnostics
1. HYPERCALCEMIA
STATE
2. FLUOROSIS

65. Backache - ? Non Spinal
 Urinary Stones ?
 Gynec Pathologies ?
 Any other ?
Ideal diagnostics

66. Ideal diagnostics
LEFT RENAL CALCULUS

67. Ideal diagnostics
LEFT RENAL CALCULUS

68. Pancreatitis
Ideal diagnostics

69. Uterine Fibroid
Ideal diagnostics

70. Ovarian Cyst
Ideal diagnostics

71. Pelvic X- Ray
Ideal diagnostics

72. Leg Swelling
Ideal diagnostics

73. Causes of Leg Swellings
Local Causes:
Vascular : Arterial / Venous/ Lymphatic
Musculo-Skeletal
Systemic Causes:
Cardiac / Renal / Liver / Anemic / Drug
Induced

74. Vascular Pathologies
Ideal diagnostics

75. LOWER LIMB DOPPLER
 ARTERIAL
Pain is the main
Complain
 VENOUS
Swelling is the main
Complain
Ideal diagnostics

76. PVD
Ideal diagnostics

77. Claudication Pain
Ideal diagnostics

78. Foot Ulcer / Gangrene
Ideal diagnostics

79. Ideal diagnostics
Peripheral artery disease symptoms include:
Painful cramping in your hip, thigh or calf muscles
after certain activities, such as walking or climbing
stairs (claudication)
Leg numbness or weakness
Coldness in your lower leg or foot, especially when
compared with the other side
Sores on your toes, feet or legs that won't heal
A change in the color of your legs
Hair loss or slower hair growth on your feet and legs
Slower growth of your toenails
Shiny skin on your legs
No pulse or a weak pulse in your legs or feet
Erectile dysfunction in men

80. Ideal diagnostics
Risk factors
Factors that increase your risk of developing peripheral artery
disease include:
Smoking
Diabetes
Obesity (a body mass index over 30)
High blood pressure
High cholesterol
Increasing age, especially after reaching 50 years of age
A family history of peripheral artery disease, heart disease
or stroke
High levels of homocysteine, a protein component that helps
build and maintain tissue
People who smoke or have diabetes have the greatest risk of
developing peripheral artery disease due to reduced blood flow.

81. PVD Symptoms
 Claudication Pain
 Ischemic Rest Pain
Ideal diagnostics

82. Ideal diagnostics
ARTERIAL DOPPLER
Even if you don't have symptoms of peripheral
artery disease, you may need to be screened if you
are:
Over age 70
Over age 50 and have a history of diabetes or
smoking
Under age 50, but have diabetes and other
peripheral artery disease risk factors, such as
obesity or high blood pressure

83. Ideal diagnostics
Complications
If your peripheral artery disease is caused
by a buildup of plaques in your blood
vessels (atherosclerosis), you're also at
risk of developing:
Critical limb ischemia. This condition
begins as open sores that don't heal, an
injury, or an infection of your feet or legs.
Critical limb ischemia occurs when such
injuries or infections progress and can
cause tissue death (gangrene), sometimes
requiring amputation of the affected limb.
Stroke and heart attack. The
atherosclerosis that causes the signs and
symptoms of peripheral artery disease isn't
limited to your legs. Fat deposits also build
up in arteries supplying your heart and
brain.

84. Venous Pathology
 Deep Vein Thrombosis { DVT }
 Varicose Veins
Ideal diagnostics

85. Varicose Veins
Ideal diagnostics

86. VARICOSE
Ideal diagnostics
Venous insufficiency is more common in
women than in men.

87. Ideal diagnostics
Symptoms of venous insufficiency include:
swelling of the legs or ankles (edema)
pain that gets worse when you stand and
gets better when you raise your legs
leg cramps
aching, throbbing, or a feeling of heaviness
in your legs
itchy legs
weak legs
thickening of the skin on your legs or
ankles
skin that is changing color, especially
around the ankles
leg ulcers
varicose veins
a feeling of tightness in your calves

88. Venous Valve
Ideal diagnostics

89. DVT
Ideal diagnostics
What is Deep Vein Thrombosis?
Deep vein thrombosis (DVT) is a serious condition that
occurs when a blood clot forms in a vein located deep inside
your body. A clot is a clump of blood that has changed from
a liquid state to a gelatinous like solid state. Deep vein blood
clots typically form in your thigh or lower leg, but they can
also develop in other areas of your body. Other names for
this condition include thromboembolism, post-thrombotic
syndrome, and post-phlebitic syndrome.

90. DVT
Ideal diagnostics

91. DVT Causes
Ideal diagnostics

92. Ideal diagnostics
Who Is At Risk?
DVT occurs most commonly in people who
are over 60 years old. Certain conditions
that alter how your blood moves through
your veins can raise your risk of developing
clots. These include:
having an injury that damages your veins
being overweight, which puts more
pressure on the veins in your legs and
pelvis
having a family history of DVT
having a catheter placed in a vein
taking birth control pills or undergoing
hormone therapy
smoking
staying seated for a long time while you’re
in a car or on a plane, especially if you
already have at least one other risk factor

93. Ideal diagnostics
Recognizing the Signs and Symptoms of
DVT
Symptoms of DVT only occur in about half of the
people who have this condition. Common symptoms to
watch for include:
1. swelling in your foot, ankle, or leg on one side
cramping pain in your affected leg that usually begins in
your calf
2. pain in your foot and ankle
an area of skin that feels warmer than the skin on the
surrounding areas
3. skin over the affected area turning pale or a reddish
or bluish color

94. Ideal diagnostics
Why Is DVT Dangerous?
You can develop a pulmonary embolism if a
blood clot moves to your lungs and blocks a
blood vessel. This can cause serious damage to
your lungs and other parts of your body.
You should get immediate medical help if you
have signs of a pulmonary embolism such as:
dizziness
sweating
chest pain that gets worse with coughing or
inhaling deeply
rapid breathing
coughing up blood
rapid heart rate

95. Ideal diagnostics
Preventing Deep Vein Thrombosis
1.keeping your blood pressure under control,
giving up smoking, and losing weight if you’re
overweight.
2.Moving your legs around when you’ve been
sitting for a while also helps keep your blood
flowing. Walking around after being on bed rest
can prevent clots from forming.
3.Make sure you take any blood thinners your
doctor prescribes if you’re having surgery, as this
can lower your chance of developing clots
afterwards.

96. Takehome message…
 Please Start to Adice “USG SCAN
SHOULDER” for shoulder Pain
 Digital X- Rays preferred than Conventional
X-Rays
 Leg Swelling
 Pain - Arterial doppler
 Swelling – Venous Doppler
 Low Backache – advise both X-Ray Spine &
USG Scan abdomen

97. Significance of RADIOLOGY
 Ever expanding , Fascinating diagnostic
Modality
 Proper & Judicious use of Radiology for
arrive at a diagnosis
 DON’T Lag behind your allopathic
Colleagues
 Keep update yourself