- Joined
- Apr 14, 2012
- Messages
- 101
- Reaction score
- 93
How many of you order Lumbar MRI for crps of the lower extremity with the absence of any lumbar/radicular complaints before sympathetic blocks?
Lumbar MRI for sympathetic block
- Thread starter Welcome123
- Start date
- Joined
- Mar 7, 2011
- Messages
- 1,666
- Reaction score
- 602
had to chuckle at this one. i have been trying to get the neurologists to order a spine MRI before they decide a patient has CRPS for years.
most of the CRPS referrals i get are unrecognized radics. need an MRI to figure it out. a real genuine CRPS referral is so rare that i would guess maybe 10% of CRPS referrals to me are really CRPS.
most of the CRPS referrals i get are unrecognized radics. need an MRI to figure it out. a real genuine CRPS referral is so rare that i would guess maybe 10% of CRPS referrals to me are really CRPS.
My thoughts exactly. So if no MRI, I order it to check for radic not as a tool for the injection. I agree with the 10% figure. Most of my crps dx come from orthos saying I fixed your "joint of choice" so you must have crps
- Joined
- Feb 1, 2005
- Messages
- 5,695
- Reaction score
- 2,655
I'm assuming you're just talking about those patients w neuropathic out of proportion, some allodynia, maybe dec rom without any other objective findings for crps per Budapest criteria? (Ie doesn't really present like a clear radic or would not have been referred)... Perhaps eval L spine, but what do you do with that info if some hnp/stenosis is present which likely doesn't fit the patients non-dermatomal/myotomal pain especially given the % asymptomatic MRI findings in gen population? Esi? Operate? Probably not.
And if they do have clear objective findings for crps, but also HNP on MRI... so what then? Attribute the crps to spine pathology? Esi? Operate? Again prob not. Unless you're thinking a crps type 2 from nerve root injury I'm not following why you'd do this.
- Joined
- Mar 7, 2011
- Messages
- 1,666
- Reaction score
- 602
it works like this. podiatrist operates on a painful foot. foot does not get better, AKA "gets worse". neurologist sees patient and notes decreased sensation, maybe some swelling, and tenderness, along with minor temp change. decides it is CRPS. sends patient to me. i note + SLR (although this test is optional) and order lumbar MRI. MRI demonstrates unhappy nerve root at L5 because of disc herniation . patient is asked if back hurts. patient says back has always hurt, when are you going to fix my foot?
patient is asked how foot became painful. table was dropped on it. why did you drop the table i opine? eyes of patient open wide - because my back hurt! ESI performed. foot is much better. do we do a LSB? depends on how much better the foot is.
i have so many stories like this i could write a book. 50 shades of CRPS - coming soon on Kindle.
patient is asked how foot became painful. table was dropped on it. why did you drop the table i opine? eyes of patient open wide - because my back hurt! ESI performed. foot is much better. do we do a LSB? depends on how much better the foot is.
i have so many stories like this i could write a book. 50 shades of CRPS - coming soon on Kindle.
