WAG Bone scan vs. MRI

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Amanda

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So my daughter has a follow up with an orthopedist on Monday for lower back pain. When he saw her a month ago, he really didn't think it was a stress reaction/fracture but only did xrays. (She had an MRI about 9 mths ago which I think played into his hesitancy to do another one.) He said bring her back in a month if the pain hadn't resolved or got worse. I've actually since taken her to another pediatric orthopedist who specializes in the spine. While he originally suspected a stress fracture, he was very confident it wasn't after his exam. I pushed a lot since I was very worried. He really thinks it is muscular. He didn't even bring up an MRI or bone scan because he was so confident. Well, it's been another 8 days and she still has pretty localized lower left back pain. I am just not comfortable with not being able to definitely rule out anything in her spine. I hate that she could be doing further damage at practice. (She's totally been modifying- mostly avoiding back extension stuff, high impact, running/jumping) We've had her skip practice on some days where practice would be back to back and have shortened some of her practice days. She's also started a little p/t. At this point, I want to KNOW. Her pain is actually not bad and it rarely hurts while at practice but I just don't like how long it has been and the fact that it seems localized in an area where you would suspect a stress fracture.

Anyway all that to ask, is there any major advantage to an MRI vs. a bone scan for checking for a stress reaction/fracture? I am sure the orthopedists gets to make the call, but I have no problem advocating for one if it is better. Thanks!
 

CoachAlex

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I have had BOTH to diagnose/rule out stress fractures. An MRI is much easier and there is no/minimal radiation (it’s magnetic). For a bone scan, you have an intravenous injection of a radioactive marker - when they do the scan, if there is “activity” in the bone (a fracture) that will be highlighted by the marker (I’m not a doctor, so please get a medical professional to explain it better). In the past, MRI technology was not as good as it is now, so bone scans were primarily used to diagnose stress fractures. Now I believe most docs use MRI. I had a bone scan for a suspected back fracture about 16 years ago. I had two stress injuries within the last 3 years that were both diagnosed using an MRI (which is significantly easier and less stressful and faster).
 

Amanda

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I have had BOTH to diagnose/rule out stress fractures. An MRI is much easier and there is no/minimal radiation (it’s magnetic). For a bone scan, you have an intravenous injection of a radioactive marker - when they do the scan, if there is “activity” in the bone (a fracture) that will be highlighted by the marker (I’m not a doctor, so please get a medical professional to explain it better). In the past, MRI technology was not as good as it is now, so bone scans were primarily used to diagnose stress fractures. Now I believe most docs use MRI. I had a bone scan for a suspected back fracture about 16 years ago. I had two stress injuries within the last 3 years that were both diagnosed using an MRI (which is significantly easier and less stressful and faster).

That is helpful! I do like the idea of limiting the radiation exposure which makes the MRI appealing. She's now had 2 full sets of xrays in the last year as well.
 

nycgymmom

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my daughter had an L5 fracture last year and the ortho did an xray and found nothing. I had to be a very strong advocate for an MRI in order to get one but thank God I did, push for one if the pain is still there, find one who will do it and don't take no for an answer. I know I probably sound abrasive but if I hadn't been "pushy" as I was I would have never found the cause of the problem. Hope a speedy recovery and the best for your gymmie. MRI always over xray to much radiation in xray.
 

Amanda

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my daughter had an L5 fracture last year and the ortho did an xray and found nothing. I had to be a very strong advocate for an MRI in order to get one but thank God I did, push for one if the pain is still there, find one who will do it and don't take no for an answer. I know I probably sound abrasive but if I hadn't been "pushy" as I was I would have never found the cause of the problem. Hope a speedy recovery and the best for your gymmie. MRI always over xray to much radiation in xray.

Thank you! I appreciate it! I am definitely not settling for the xrays results!
 
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CoachAlex

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Often docs will X-ray first because usually they can do it in-office, but stress fractures that are not severe, or that are not fully stress fractures but is on its way to becoming one, can’t always be seen on an x-ray. What they usually can see though are changes in the bone that could be an indication of an injury which would lead them to order an MRI.

I understand wanting to know, but from personal experience, back injuries can be tricky. I had back pain for YEARS as a gymnast - I mean, laying on the floor in the fetal-position in between turns at practice. MRI, bone scan, CT scan - no fractures.

Eventually I saw a DO who did a set of X-rays with me standing up - even I could see all the issues - very very minor scoliosis, one hip was higher than the other, etc - basically a lot of structural issues, some of which still have to be addressed by a PT now (I’m still a competitive athlete, just not in gymnastics).

So, there is a good chance that its NOT a fracture, but that doesn’t mean that a) there isn’t something that can be corrected, and b) that it isn’t painful.
 

Amanda

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Often docs will X-ray first because usually they can do it in-office, but stress fractures that are not severe, or that are not fully stress fractures but is on its way to becoming one, can’t always be seen on an x-ray. What they usually can see though are changes in the bone that could be an indication of an injury which would lead them to order an MRI.

I understand wanting to know, but from personal experience, back injuries can be tricky. I had back pain for YEARS as a gymnast - I mean, laying on the floor in the fetal-position in between turns at practice. MRI, bone scan, CT scan - no fractures.

Eventually I saw a DO who did a set of X-rays with me standing up - even I could see all the issues - very very minor scoliosis, one hip was higher than the other, etc - basically a lot of structural issues, some of which still have to be addressed by a PT now (I’m still a competitive athlete, just not in gymnastics).

So, there is a good chance that its NOT a fracture, but that doesn’t mean that a) there isn’t something that can be corrected, and b) that it isn’t painful.
Thanks for sharing your experience! It's interesting as we know she has some mild scoliosis and that one of her legs is slightly longer than the other- I wonder if these factors contribute. I still would like to be able to eliminate stress fracture as I know it is something that can get so much worse through continued training.
 
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Amanda

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Hmm, I would question the one leg longer than the other thing. Has anyone checked for rotated pelvis? The mild scoliosis should not be an issue for gym.
Are you thinking a rotated pelvis might cause the leg length discrepancy? She actually was diagnosed with juvenile arthritis when she was 4. She has been in remission for about 5 years. We think that was the cause of the differences in her leg lengths. But I suppose we don't know that for sure. Who would check for that? The orthopedist? Physical therapist?
 

Flyaway

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If you rule out a stress fracture, if you can find a DO in your area that does manual manipulation (sometimes called OMM - osteopathic manual manipulation) it might be worth taking her in to have her evaluated. Like CoachAlex mentioned above, they would be able to evaluate for structural abnormalities that may be causing the pain and also do manual treatment to alleviate it and potentially fix it.
 
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ldw4mlo

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Often docs will X-ray first because usually they can do it in-office, but stress fractures that are not severe, or that are not fully stress fractures but is on its way to becoming one, can’t always be seen on an x-ray. What they usually can see though are changes in the bone that could be an indication of an injury which would lead them to order an MRI.

This and it also has to do with insurance reimbursement and costs. Most docs would love to go right to MRIs, but insurance very rarely will approve that.

Its also based on current standard of care. X-rays and standard treatment, be it casts, boots, wraps, and PT etc.... depending on the injury. And also will an MRI change the course of treatment? If not, it is unlikely to be approved. So some of it is insurance driven and what the current standard of care is. So if the treatment is similar, its treatment first, then further more expensive testing if unresolved.

Can't speak to backs. But as an example daughter rolled ankle. Xray inconclusive, but unlikely a fracture. Doc would of preferred an MRI but it wasn't going to change treatment. And insurance was not going to approve. Treatment the same, boot, no weight bearing exercise. Follow up in 2 weeks, if there was a break, healing would show up on Xray. No break, ease back into activity. If pain had continued would of then been able to get approval for MRI. Our story ended with no MRI needed.

And I am sure backs are way more complicated.
 
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meganliz77

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My DD was having a lot of hip pain, or that is how she described it. Hurt to walk, run doing anything. Was limping everywhere. Took her to the chiropractor (honestly because I knew someone whose daughter was a dancer who had similar issues and because it was the quickest to get into). Turns out her pelvis was out of place. Once that was fixed she felt a MILLION TIMES better. Her legs were also different lengths due to the issue. Now DD can tell me when she is 'out of whack' and usually one trip to the chiropractor and she is feeling better. I think her flat feet cause a lot of alignment issues generally speaking.
 
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CoachAlex

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Yes, if one leg is slightly longer than the other it is usually because of a rotated pelvis. I have a PT who is great at correcting this, but I would assume a chiropractor would also be able to do this. It is possible that her arthritis caused a leg-length difference, but it’s worth having checked out. Have you ruled out the arthritis as a cause for the back pain? I know you said she is in remission, but is it something that flares with a growth spurt, etc?
 
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Amanda

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Saw original orthopedist this morning and he recommended an MRI- without any prompting by me. Right now she is scheduled for Saturday. Trying to move it sooner as she has to be out of practice until he gets results. Thanks for of the replies!
 

Amanda

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If you rule out a stress fracture, if you can find a DO in your area that does manual manipulation (sometimes called OMM - osteopathic manual manipulation) it might be worth taking her in to have her evaluated. Like CoachAlex mentioned above, they would be able to evaluate for structural abnormalities that may be causing the pain and also do manual treatment to alleviate it and potentially fix it.
I will definitely look into this if we can rule out the stress fracture. Thanks!
 

Amanda

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Yes, if one leg is slightly longer than the other it is usually because of a rotated pelvis. I have a PT who is great at correcting this, but I would assume a chiropractor would also be able to do this. It is possible that her arthritis caused a leg-length difference, but it’s worth having checked out. Have you ruled out the arthritis as a cause for the back pain? I know you said she is in remission, but is it something that flares with a growth spurt, etc?
I am pretty sure it's not arthritis. She's regularly followed by a rhuem. Her bloodwork is completely clear- and it's always shown up in hers. Also all of her visible joints are completely fine. It's probably not impossible but I think it's unlikely. I appreciate your continued input. You've given me some more things to think about!
 
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Amanda

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My DD was having a lot of hip pain, or that is how she described it. Hurt to walk, run doing anything. Was limping everywhere. Took her to the chiropractor (honestly because I knew someone whose daughter was a dancer who had similar issues and because it was the quickest to get into). Turns out her pelvis was out of place. Once that was fixed she felt a MILLION TIMES better. Her legs were also different lengths due to the issue. Now DD can tell me when she is 'out of whack' and usually one trip to the chiropractor and she is feeling better. I think her flat feet cause a lot of alignment issues generally speaking.
Thanks for sharing your experience. I've been hesitant about a chiro. but if rule out spine issues, I might reconsider if the pain continues!
 

UnoMas

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Another culprit can be SI joint pain. My daughter has been dealing with back issues for 3 years now and after about one million tesrs showing nothing it seems to be the diagnosis that fits the best. She has a great PT who quite literally moves her joint back into place...frequently. She’s also had steroid injections which have also given her some relief.
 

Amanda

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Another culprit can be SI joint pain. My daughter has been dealing with back issues for 3 years now and after about one million tesrs showing nothing it seems to be the diagnosis that fits the best. She has a great PT who quite literally moves her joint back into place...frequently. She’s also had steroid injections which have also given her some relief.
I have done a bit of googling on SI joint pain as well- as it seems to also be in the general area of where she is complaining. I'm sorry your dd has been dealing with pain for so long! That must be so frustrating.
 
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Amanda

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Saw original orthopedist this morning and he recommended an MRI- without any prompting by me. Right now she is scheduled for Saturday. Trying to move it sooner as she has to be out of practice until he gets results. Thanks for of the replies!
We were able to move her up to today and MRI was done this morning. Will meet with ortho. tomorrow to discuss results. Nervous but glad we will be getting a more definitive answer on the stress fracture front. If it's not that, I now have some good follow up questions to ask!
 
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