The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: reggieandabears on August 01, 2006, 08:11:37 PM

Title: satnding vs supine x-rays
Post by: reggieandabears on August 01, 2006, 08:11:37 PM
   I have a question on the possibility of differing diagnosis of a condition (arthritis of knees) when using a standing or laying down x-ray.
   If you are diagnosed with moderate arthritis from a supine (lying down) position x-rays does the severity of the joint narrowing increase with a standing x-ray and does the diganosis increase in severity as well?
   I am asking because it seems the OS is passing off my pain as mild arthritis when the x-rays(lying down) showed only mild to moderate joint space narrowing, but I seem to have more pain than seems described in mild cases of arthritis. It is less painful when sitting and increasingly worse when weight bearing. Should I ask for standing x-rays? Or will it make no differance? Thanks
Title: Re: satnding vs supine x-rays
Post by: emphatic on August 01, 2006, 08:32:57 PM
A standing Xray is the gold standard for viewing joint space. However, that's only part of the story when it comes to arthritis. Arthritis is a catch-all term for all kinds of damage to the articular cartilage in the knee.

Pain is very subjective. The location of the chondral lesions has a lot to do with how much pain a patient feels, as well as the severity of the lesions. Typically, chondral lesions are graded I - IV, with IV being when the articular cartilage is completely worn away and the bone is exposed.

Have you had an arthoscopy, where the doctor would have viewed the inside of your knee? If not, it's pretty hard to tell the level of arthritis based soley on plain film Xrays. An MRI can give more information, but it still isn't nearly as good as a direct view into the joint with an arthroscope.

Have you been offered any other treatment options, such as viscosupplementation? Do you know if you have chondral damage throughout the knee (all three compartments) or just one or two?

If your doctor is fluffing you off, it's time to find a new doctor -- preferably one who specializes in articular cartilage injuries and arthritis.

Good luck!

Title: Re: satnding vs supine x-rays
Post by: knee deep in Goo on August 02, 2006, 12:22:19 AM

Here is a link that may or may not be helpful for you.  If you send away for the DVD it will show you all the stages of joint space.

Also Tell your doctor the type of pain you have.  Is it ice pick pain? Do you feel your bones scrapping?  Raking pain?  Did you go to a sports medicine OS?
Title: Re: satnding vs supine x-rays
Post by: reggieandabears on August 02, 2006, 01:49:27 AM
   I had an arthroscope in April on the right knee, microfracture etc done. Diagnosed arthritis.
   The left knee began to hurt, even worse that the right one had initally, maybe in part to the long period on crutches,12 wks and counting. He took an x-ray of the left knee and pointed out the narrowing space, squaring off of the femur and a bone spur. Diagnosed mild arthritis gave me vicodin after Mobic hasn't worked. 
  I'm wondering if he doesn't want to persue it due to my obesity(sigh, yes fat, forty and female) he stated quite fervently that my right knee was the second worst he had ever done due to the fat in the area.
    I have read so much in this site to know that when the joint narrows and bone spurs form it is pretty well down the road to ouchville.
  I have good ROM and when seated or doing non-weight bearing PT the pain is not very bad. On rising, sitting, walking,standing or most agonizing of all squatting and stairs the pain is a burning, grating pain. The more of the previous the more pain. I am worried about it because I would not look fondly upon another round of the Roto Rooter knee surgery.
  I am getting a second opinion from a doctor at the Houghston clinic in Columbus ,Ga. but wanted to know if I should ask for the standing x-rays. Thanks for the info!