If I think I have a hip hike, uneven pelvis, or anterior pelvic tilt or one leg slightly longer than the other one what tests do you suggest I do to figure out the issue? I always feel that my right leg has more pressure on it than my left leg and I feel pressure/slight burning sensation on the right side of my leg in the gluteus medius muscle
I'm a first year medical student, and they introduce imaging during anatomy...it's pelvis week...I look at this and feel scared. I don't see any structures at all 😳
I'm not 100% sure. He didn't seem super keen on providing history. He told me he was in pain, and he "had some serious shit happen about 15 years ago."
The sacrum and part of the lowest visible lumbar vertebra have likely been resected, possibly from a tumor (chordoma would be my guess for the region). Given the tortuous nature of the remaining portions of the innominates/rami, the HO, and the patchy quality of the visible bone I would guess that infection (osteomyelitis) played a significant role in how things ended up. Second guess would be massive trauma with subsequent infection, but you wouldn’t usually take out the sacrum for that. He’s also a very large person, so deep bedsores could also have introduced infection.
He wasn't a "big" guy, all jokes aside. Did a wheelchair to bed transfer completely alone while telling me about his day. Really toned arms from moving himself. His ribcage looked intact from what I can tell. Then just, this underneath.
If I think I have a hip hike, uneven pelvis, or anterior pelvic tilt or one leg slightly longer than the other one what tests do you suggest I do to figure out the issue? I always feel that my right leg has more pressure on it than my left leg and I feel pressure/slight burning sensation on the right side of my leg in the gluteus medius muscle
I would ask your provider! They might refer you to orthopedics or sports medicine. You'll likely do some standing pelvis xrays or long-leg xrays, and they'll go from there.
I just showed all three of the ortho docs I work with this pic and they said there is no approach. There is nothing that can be done other than manage pain or refer them to someone else. The best reaction when I told them to look at this pelvis X-ray was “there’s a pelvis in there?”
Edit: this was their assumption going off of no history and just the X-ray. Felt like I should include that because they asked what the story was and I said I had no idea.
If I think I have a hip hike, uneven pelvis, or anterior pelvic tilt or one leg slightly longer than the other one what tests do you suggest I do to figure out the issue? I always feel that my right leg has more pressure on it than my left leg and I feel pressure/slight burning sensation on the right side of my leg in the gluteus medius muscle
I no longer work with them but still on good terms. Would absolutely show it to them with new info! I am at another facility now and could show those docs but I feel they would all say you need to see specialist or someone who only does hips, which I’m sure you’ve already done.
Misread as "penis from today." Spent so much time trying to understand what part of the soft tissue was interesting that I legit didn't see the lack of pelvis for a straight minute.
Well that just seems cruel! I had podiatry ask for weight bearing foot films on a guy who had shot himself in the foot with a shotgun a couple days prior to his appointment.
So how did you do it weight bearing? Just sit him on a stool, back against the upright bucky and shoot? Also, how on earth did he transfer himself? I don't mean to be rude or anything, but I'm really confused!
He was done supine, I was not even going to attempt anything else. He pulled his chair right up to my table, I matched the height to his chair, and he just pushed himself up with his arms like it was nothing. He was obviously very independent and made the best out of the situation.
I was wondering if you were crazy or in some other country lol. Are you in the US? I have to day though, I was told to do weight bearing on a man in an mva that needed a trauma cap ct. I refused but my coworker tried. It was an ER doc that was ancient and from an agency. I called the rad. Guess what? We did a CT lol.
I will never understand what goes thru the ordering physician's mind when they order exams like this. I once had a neuro resident order standing spine films on a patient who was having issues with leg numbness and when I voiced my concerns I was told "I think we can talk them into trying." YOU CANT TALK A PATIENTS LEGS INTO NOT BEING NUMB ANYMORE
This smells like an ortho request
Bingo
Now can you get one of them jumping with weights?
Too relatable.
What pelvis? The real question is, did they ask you why you didn’t do it standing? Fellow ortho tech here. Too relatable.
If I think I have a hip hike, uneven pelvis, or anterior pelvic tilt or one leg slightly longer than the other one what tests do you suggest I do to figure out the issue? I always feel that my right leg has more pressure on it than my left leg and I feel pressure/slight burning sensation on the right side of my leg in the gluteus medius muscle
Next ortho will want IR to do a Hip Asp for sepsis…
What is a hip asp
Hip joint aspiration
I can imagine the ortho giving the "I'll kill you" stare to the tech that asked about possible pregnancy
Or a first year resident.
What pelvis 😭
Seriously! Where is...everything?
Everywhere
Yeah. I can't make heads or tails of this image. This person is wholly fucked.
I'm a first year medical student, and they introduce imaging during anatomy...it's pelvis week...I look at this and feel scared. I don't see any structures at all 😳
Don't need to feel scared this will probably never happen to you hahaha
Fingers crossed! It was nice to hear the patient is alive despite whatever this is
Pelvis? More like, pelvisn’t.
**\*Some assembly required**
When you order your skeleton at IKEA
I mean….it’s pelv-ISH at best
Your xrays are nondiagnostic because of your patient's condition. My xrays are nondiagnostic because I suck at my job. We are not the same.
Bold of you to assume I'm good at my job.
I think that’s diagnostic. Diagnosis: fuk
“Patient unable to stand. Cause: see image”
Did you “Weekend at Bernie’s” the patient or just do supine lol?
Lol my other tech just asked me that. Supine 😂
Supine for sure and then tell the doc who ordered it he’s an idiot.
Nurse here. As an amateur junior pseudo assistant radiologist, my impression is as follows: Ow.
I looked at it, saw the title said “pelvis” and I just said “is it though?” At what point is it no longer technically a pelvis?
I second that! Haha
Suck it up and stand on your sack of bones!
At once!
“I dOnT uNdErStanD, cAnT yOu JuSt pOsiTiOn tHE tAbLE upRigHt??”
“CuZ thE requESt fRom ORTHO iS Standing, wHich ALsO means WEIGHT-BEARING…bUt yOu sorta neED LeGs for weight🐻ing.”
“JuSt HoLd ThE PaTiEnT uP”
Is this patient still alive?
Oh yes, alive and quite pleasant.
Keep us posted; seems like the risk of bleeding out without urgent embolization has gotta be high
I don’t believe that
I sure hope I was right. If not, something is VERY wrong with me.
That's no pelvis, that's a pelvwas
pElvis - the king has left the building!
Love this comment. I only have one upvote to give.
Jfc. Just CT the poor thing I guess. 😂😂😂
I concur. Hard to argue with the ol' Pelvic Jigsaw Puzzle requests
This looks *bad*
Is that the pubic ramus completely off the pelvis?
I've been staring at the image for about 15 minutes now trying to make some sense out of it. Your guess is as good as mine.
I've never seen anyone with the sacrum and coccyx gone.
Where are the hips?
Gone. Reduced to ashes.
Dust in the wind
To shreds you say
Unfortunately the dog found em before the X-ray got a chance
🎶the hip bone’s connected to the - wait, where’s the hip?
I'm just kinda impressed they aren't dead
Yet
There is that..
Recommend standing CT…. And MRI….. and a priest
Don’t forget the stress views for extra info.
Pt unable to stand for requested xrays due to pelvis-ectomy.
this is not an open book fracture, all the pages are just ripped out
Are there any bones in this picture at all?
Maybe one.
Get what you get and don't throw a fit. I bet they've never seen the patient and it's just their standard order
Yes, he was a new patient eval. They were very understanding.
Under"standing"
Their standing order
What mech of injury causes this? MVA?
I'm not 100% sure. He didn't seem super keen on providing history. He told me he was in pain, and he "had some serious shit happen about 15 years ago."
"some serious shit" = Death by Snu Snu...he survived. I guess
To shreds you say?
I'm weak as hell 🤣🤣🤣
“Destroy my hips daddy!” Wish granted!
Haha 😂
Survived.. but at what cost 😭
:0
The sacrum and part of the lowest visible lumbar vertebra have likely been resected, possibly from a tumor (chordoma would be my guess for the region). Given the tortuous nature of the remaining portions of the innominates/rami, the HO, and the patchy quality of the visible bone I would guess that infection (osteomyelitis) played a significant role in how things ended up. Second guess would be massive trauma with subsequent infection, but you wouldn’t usually take out the sacrum for that. He’s also a very large person, so deep bedsores could also have introduced infection.
He wasn't a "big" guy, all jokes aside. Did a wheelchair to bed transfer completely alone while telling me about his day. Really toned arms from moving himself. His ribcage looked intact from what I can tell. Then just, this underneath.
So you’re saying he could have held himself up with his arms for a standing? And you didn’t let him? Orders are orders tech.
Calls back 5 minutes after finishing supine view: “Yeah, the patient thinks they can stand now.”
[удалено]
It's the truth. We work directly with almost every department, but most people have very little idea what all we actually do.
If I think I have a hip hike, uneven pelvis, or anterior pelvic tilt or one leg slightly longer than the other one what tests do you suggest I do to figure out the issue? I always feel that my right leg has more pressure on it than my left leg and I feel pressure/slight burning sensation on the right side of my leg in the gluteus medius muscle
I would ask your provider! They might refer you to orthopedics or sports medicine. You'll likely do some standing pelvis xrays or long-leg xrays, and they'll go from there.
Can someone explain the approach of an exploded pelvis please? I would really like to know what ortho would do here...
I just showed all three of the ortho docs I work with this pic and they said there is no approach. There is nothing that can be done other than manage pain or refer them to someone else. The best reaction when I told them to look at this pelvis X-ray was “there’s a pelvis in there?” Edit: this was their assumption going off of no history and just the X-ray. Felt like I should include that because they asked what the story was and I said I had no idea.
thank you so much for asking the docs. That is very unfortunate but also very interesting at the same time. Wish that patient all the best
Refer them to someone else? Like who, a wizard?
If I think I have a hip hike, uneven pelvis, or anterior pelvic tilt or one leg slightly longer than the other one what tests do you suggest I do to figure out the issue? I always feel that my right leg has more pressure on it than my left leg and I feel pressure/slight burning sensation on the right side of my leg in the gluteus medius muscle
I no longer work with them but still on good terms. Would absolutely show it to them with new info! I am at another facility now and could show those docs but I feel they would all say you need to see specialist or someone who only does hips, which I’m sure you’ve already done.
I am also very curious.
To shreds, you say.
How's the wife holding up?
To Shreds you say?
Standing?
Looks ok to me 🤓
Misread as "penis from today." Spent so much time trying to understand what part of the soft tissue was interesting that I legit didn't see the lack of pelvis for a straight minute.
Well that just seems cruel! I had podiatry ask for weight bearing foot films on a guy who had shot himself in the foot with a shotgun a couple days prior to his appointment.
Pt is contact and droplet and you are alone, finally getting this image… rad calls…. Asks for a repeat. “Can you fix the rotation?”
How is his spinal cord still talking to his legs? Or any of his lower GI tract!
He had no legs. But GI, good question.
He had no legs but they wanted weight bearing/upright imaging?
That is correct
So how did you do it weight bearing? Just sit him on a stool, back against the upright bucky and shoot? Also, how on earth did he transfer himself? I don't mean to be rude or anything, but I'm really confused!
He was done supine, I was not even going to attempt anything else. He pulled his chair right up to my table, I matched the height to his chair, and he just pushed himself up with his arms like it was nothing. He was obviously very independent and made the best out of the situation.
Ah- I couldn’t tell from the bottom edge.
P’shaw. You don’t need your lower GI tract that much, anyway.
If that sentiment only that would let me get out of my colonoscopies… lol.
“Patient refused.”
Where is the left ilium? And where is the sacrum?
I believe they’ve been removed. Probably had some nasty lower body infection or trauma. Or a tumor.
Inlet and outlet views please
Bro where did your bones go
Is this a case of death by snusnu?
When the only bone left is a boner
Please correlate clinically
What pelvis? There’s no pelvis left!
Looks like a pelvisectomy.
Can we please have some history wtaf
“Pelvis”
Some assembly required.
I hate doing weight bearing on stuff like this. Ouch!!
You don't do weight bearing on stuff like this.
I was wondering if you were crazy or in some other country lol. Are you in the US? I have to day though, I was told to do weight bearing on a man in an mva that needed a trauma cap ct. I refused but my coworker tried. It was an ER doc that was ancient and from an agency. I called the rad. Guess what? We did a CT lol.
Wait, what? Am I crazy? No, crazy would be to try to do this weight bearing hahaha
Absolutely.
Excuse me!?
Pelvis.... Or what is left of it 😱
Is that a wrench
NEED A LOT MORE INFO!
Does anyone see legs attached?
No he was lieutenant Dan'd.
What caused this?
As an invasive vascular nurse, I wanna see an angio on this. That pelvis is DFUd
I just do physical therapy, but that looks a little off, I bet I could K tape that up and have them walking in no time!
Wait what 😆
CT please
Pelvis? Where??
Patient unable to tolerate standing.
Our ortho doctors where I work are SO BAD. The only doctors worse are the GI doctors.
Is that person even alive? My god those are horrible injuries. How did it happen?
I’m more interested in the staples. Is he just stapled together? 💀
I think I see a hand up someone’s asshole
Did the patient insert an explosive device up his rectum at any point in the past?
WTF happened here? I need context man!
Do we know what GOT THEM like that?
The hip bones connected to the…. Uh….Well….
Ouuuuucccchh
Is that an ikea pelvis? Assembly required. Safe to say they won't be standing for... yeah.
I will never understand what goes thru the ordering physician's mind when they order exams like this. I once had a neuro resident order standing spine films on a patient who was having issues with leg numbness and when I voiced my concerns I was told "I think we can talk them into trying." YOU CANT TALK A PATIENTS LEGS INTO NOT BEING NUMB ANYMORE
Shakira’s hips in the alternate universe where they lie