RJ @northwoods1980
musculoskeletal radiologist USA Joined February 2011-
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Atypical spondy. All things are possible
Trying to sort out the pain generator when we see different path probably the most difficult part. Sup labral tear and spin-glen notch cyst but also likely denervation edema teres minor, possible quadrilateral space synd...
Shows the harm of overcalling/misread. Don't call Mets along a joint line please. This patient was over staged and as a result, treatment was modified accordingly by oncology.😩
Trust us. Imaging not a substitute for qualified/skilled history and exam. Second, hand x-rays are not a substitute for wrist series. Two years later, this man and attorney agree.
Give this little avulsion the respect he deserves. Because as you know, he portends pathology
This new retiree got lucky. Picked up his pancreatic tail adenocarcinoma which remained confined to the tail and spleen thankfully with a clean resection. He was CT'd for his life-saving diverticulitis. Luckily he may go on hopefully to still enjoy retirement.
Young patient. diagnosis of psoriatic arthritis. I'm not sure I've seen this level of destruction and pannus with psoriatic. Any thoughts? Clearly the ligaments are destroyed and findings of instability.
Nice! I'm stealing these for my techs
Somewhat unusual. The low energy lateral compression type 1 insufficiency injury skipping to the contralateral side due to altered biomechanics?
Six weeks later. What's take-home point? For primary care? An x-ray does not substitute for a competent history and physical exam.
First of all, when you see this in a 60-year-old you really question the whole "intelligent design theory". Second, you understand/can appreciate why this person has paraspinal sarcopenia no fault of their own!
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4K Followers 5K Following @BCMHouston Professor of Radiology / @NYUAlumni Passionate ❤️ about Mentoring and Diversity - #AAWRAlly!! / #Runner #Yoga #Meditation@northwoods1980 A tall handsome man In a dusty black coat with A neg right hand
@northwoods1980 No. Some can be reached with a needle and strong forearm and some can’t. But if it avoids surgery then it’s got to be worth it.
@northwoods1980 I’ve never been that impressed with aspirating these. Almost always recur, and we end up operating anyway. But I do discuss it as a choice with the patient
@northwoods1980 We often recommend it for those that are compressing the suprascapular nerve but inform patients theres a high chance of recurrence! Patients then decide if want to try or undergo arthroscopy!
@northwoods1980 12 pack a day will do that to you Ceramic on ceramic time
They should make an NSAID that doesn’t hurt your kidneys. All other medical research should be directed to this cause.
@panscan27 @northwoods1980 I came from one of those oppressive regimes, a country who had that very line of thinking. I refuse to ignore people’s (students) suffering because others have it worse. Residents have some of the highest suicide rates. The high cost & predatory debt of med school is absurd.
@panscan27 @northwoods1980 Maybe there can even be a tiered system. First 2 years free for all to allow those who hate it to quit so they’re not trapped. Then tiered cost depending on specialty. But there has to be a better way out of the ridiculous 100s of thousands of dollar debt students have now.
@DrJN_SportsMed @northwoods1980 Also shows up bone bruising and other soft tissue pathology
@northwoods1980 As an immigrant who worked her butt off to become successful, I’m disgusted by that behavior and the implications of that article. They’re not only false but intentionally stirring up vitriol against other doctors. The worst kind of virtue signaling grifter.
@GoGruentzig @northwoods1980 I live in NYC and even I struggle with cost of living… as a surgeon and main provider with young children. It’s 5x more expensive than when I was in PA. But I’m lucky. What PCPs make here is insultingly low. My PAs in Pennsylvania made more than PCPs in NY. They had houses etc.
@Xangrydocs Okay so you’re just being weird. Got it.
@northwoods1980 But also a standard trauma wrist series should include ulnar deviation, angulated scaphoid, and clenched fist views IMO, to increase sensitivity for subtle injuries
@northwoods1980 @IR_Doctor I mean there's a lot of sanctioned baby murder in the Bible so if you're hoping to win an argument with these people you're sorely mistaken.
Smallest residual fluid I’ve seen. Would probably overlook it if I didn’t know the leak was at that level/foramen.
@northwoods1980 Didn’t need that last image. Just by the text I knew where that was going.