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#140281 - 04/18/09 02:52 AM bone growth seen on xray
poodlegirl Offline
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Registered: 12/01/07
Posts: 2254
Loc: Houston
I am having a bone scan on the 22nd because my doctor (an orthopedist) saw a white area on the xray of my left shin bone. He said that it may just be an area of extra bone growth, but depending on what he sees with the bone scan, he may order an MRI.

This leaves me with many questions. Does anyone have any ideas? This area is exactly where I have my worst shin splint pain (I have chronic shin splints). Is he looking for calcification or bone growth due to enthesitis? Can you get that from repetitive stress (hypermobility) as opposed to an inflammatory condition? Can you get inflammatory type bone growth or calcification in just one area?

From what I have read, I think he may also be looking for a stress fracture.

I went to the orthopedist to have my knees and shoulders evaluated and PT prescribed so that I can strengthen the muscles around these joints. But he saw this area on the knee xray that may not be normal. He also finally diagnosed my 'sitting bone' bursitis that I have been suffering with for 20 years without knowing what it was (rheumy attributed it to fibromyalgia!!!!), so I think I like this doctor.

Brenda
_________________________
Brenda

undifferentiated spondyloarthropy, HLA-B27+, iritis, naproxen 500 mg, 2x/day, trochanter bursitis, Joint Hypermobility Syndrome, migraines, SI joint dysfunction/hypermobility, DDD L4/L5 and L3/L4, straightening of cervical spine, diabetes, sleep apnea.

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#140303 - 04/18/09 07:39 AM Re: bone growth seen on xray [Re: poodlegirl]
TennisAce Offline
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Registered: 09/19/05
Posts: 1317
Loc: NJ
Xray can show bone growth due to repair from an injury too. My daughter's first xray of her L5 revealed she had new growth. The body was trying to repair itself from a stress fracture in her L5 four months prior. Poor kid had been playing tennis with a stress fracture for 4 months. I know her back doc now orders MRIs to rule out stress fractures (usually pain from her hypermobile SI joint now).

We love our Peds Rhumy. However our sports med ortho was the first one to diagnose her juv. arthritis. He referred her quickly to the Peds Rhumy who then differentiated which type. Anyway, I think both docs are very helpful in the process of determining things, and hopefully they can work together to help you!
_________________________
Daughter diagnosed 2004; son diagnosed 2006. Both are currently without spondy meds and currently in a medicine induced remissions. One has been pharma free for 3 years; the other one for 2 years.

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#140312 - 04/18/09 08:31 AM Re: bone growth seen on xray [Re: TennisAce]
hydropsyche Offline
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Registered: 10/10/08
Posts: 99
I have running friends who have chronic shin splints who don't have SpA. It does seem like stress fractures can be part of that.

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#140458 - 04/20/09 10:28 AM Re: bone growth seen on xray [Re: hydropsyche]
JenInCincy Offline
Registered Visitor

Registered: 05/19/08
Posts: 13279
Loc: Cincinnati, OH
Brenda,

The white area is probably both bone growth AND a stress fracture. I'm one of those runners who has suffered with this injury, so I'll tell you what I know. I may not always use technical terms smile

The muscle on the front of the shin is connected to the bones, the tibia and the fibula. The tibia is the bigger one "up front." If that muscle is irritated or if the tendon connecting it to the bone is inflamed (both generally caused by overuse although in the case of spondy a case could be made that is is disease related enthesitis), you feel the pain of "shin splints." For runners, icing the inflamed area and cutting back on the mileage - as well as making sure you're properly fitted for the right running shoes for your feet and gait - can be the fix. If ignored or not managed, the tension caused by shin splints can actually pull on the bone enough to cause a hairline fracture - a stress fracture. These are not always painful, although sometimes they are very painful.

Stress fractures cannot be seen on x-ray right away. They are too small. However, after they start to heal (within 1-2 weeks) they CAN be seen on x-ray. Or more correctly: the new bone growth can be seen. IMO, based on your description, this is probably what you are seeing - new bone growth that is likely repairing a small fracture.

A bone scan will show a similar picture, only with much finer resolution.

The good news is that other than avoiding running and jumping, healing a tibial stress fracture is unlikely to have a major impact on your lifestyle. When I had mine (one in each leg! definitely caused by over-aggressive marathon training) I took 6 weeks off running. I didn't even run across the street or up the stairs! But I did cross-train to maintain my fitness and weight... my sports med doc instructed me that anything but jumping-type activity was fine, so I did stairmaster and elliptical and spinning classes. Swimming was allowed but it doesn't interest me smile Walking was fine, no limits to it. Weight training was fine to continue as well, which I did.

Hopefully this makes sense! If anything I said was confusing please ask me to clarify smile Hope you get some useful answers and guidance on dealing with whatever's going on.
_________________________
Jen, 42, happy partner of James and Moma to Evan, 14, & Lucy, 12.5 (Crohn's dx @ age 3; on Remicade since April 2010.) I take piroxicam, Flexeril, & Nucynta ER nightly. 3 anti-TNFs didn't pan out for me.

"Science is the father of knowledge, but opinion breeds ignorance." -- Hippocrates

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#140472 - 04/20/09 01:43 PM Re: bone growth seen on xray [Re: JenInCincy]
catwoman Offline
Registered Visitor

Registered: 12/04/07
Posts: 892
Loc: Kansas City
It can also be a enchondroma aka a "bone island," which is a benign tumor that appears as a white spot on x-ray. Bone islands can be bothersome or not at all.

I have one in my femur found incidentally, and it doesn't bother me at all.

It sounds like he is an excellent doctor!!

Here is a link for more information:

http://orthopedics.about.com/cs/tumors/g/enchondroma.htm

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#140931 - 04/25/09 10:39 AM Re: bone growth seen on xray [Re: catwoman]
poodlegirl Offline
Registered Visitor

Registered: 12/01/07
Posts: 2254
Loc: Houston
Thanks for all the responses! They gave me some good info to think about.

I had my bone scan on Wednesday and I am anxious to get the results. But the paper work said 5 to 8 business days. Sigh.

I did get a peek at the picture. But I don't know what to make of it. My bladder was very bright. Even though I went to the bathroom twice right before the scan, I had to go again so badly at the end of it I couldn't take too much time to look at the picture. But it seemed like my whole spine was lit up, which is weird because it doesn't generally bother me. It looked like my sternum, the tops of my shoulders, and the tops of my hip bones were about as bright as my bladder. I really didn't see much in the shin bone area. But I was pretty distracted by seeing the outline of how fat my legs are! ugh! I was hoping that I was looking at someone else's scan!

Anyway, I'll post again when I get the final results.

Brenda





_________________________
Brenda

undifferentiated spondyloarthropy, HLA-B27+, iritis, naproxen 500 mg, 2x/day, trochanter bursitis, Joint Hypermobility Syndrome, migraines, SI joint dysfunction/hypermobility, DDD L4/L5 and L3/L4, straightening of cervical spine, diabetes, sleep apnea.

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#141064 - 04/27/09 06:26 AM Re: bone growth seen on xray [Re: poodlegirl]
JenInCincy Offline
Registered Visitor

Registered: 05/19/08
Posts: 13279
Loc: Cincinnati, OH
Bright bladder is normal on a bone scan.... the bright spots you saw in other places might be normal or might show signs of increased bone metabolism - which signifies either inflammation or fracture, or maybe something else for all I know! I'm surprised you had a full body scan for a problem in your shins... did they do a focused scan of the lower legs also? Also - 5 to 8 business days for radiology results is outrageous and ridiculous! There is no way it should possibly take that long to get those films ready. If it were me I'd be calling the doctor's office pestering already! Good luck - hope you get answers.
_________________________
Jen, 42, happy partner of James and Moma to Evan, 14, & Lucy, 12.5 (Crohn's dx @ age 3; on Remicade since April 2010.) I take piroxicam, Flexeril, & Nucynta ER nightly. 3 anti-TNFs didn't pan out for me.

"Science is the father of knowledge, but opinion breeds ignorance." -- Hippocrates

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#141106 - 04/27/09 08:51 AM Re: bone growth seen on xray [Re: JenInCincy]
poodlegirl Offline
Registered Visitor

Registered: 12/01/07
Posts: 2254
Loc: Houston
Jen, good question about the full body scan. They did do a focused scan on my shins, but he ordered the full body scan because I have a diagnosis of seronegative spondyloarthropy and was complaining about my shoulders as well as my knees. He ran full bloodwork, too. He seems to be very thorough.

Thanks for telling me about the time frame for radiology results. I will call the office today and see if I can get some info!

Brenda
_________________________
Brenda

undifferentiated spondyloarthropy, HLA-B27+, iritis, naproxen 500 mg, 2x/day, trochanter bursitis, Joint Hypermobility Syndrome, migraines, SI joint dysfunction/hypermobility, DDD L4/L5 and L3/L4, straightening of cervical spine, diabetes, sleep apnea.

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#141880 - 05/04/09 03:43 PM Re: bone growth seen on xray [Re: poodlegirl]
poodlegirl Offline
Registered Visitor

Registered: 12/01/07
Posts: 2254
Loc: Houston
Ok. I haven't given the update on this until now because I have been a bit depressed about it. The results came back 'normal'. Which is good in a way, but I guess that just means that my pain is from hypermobility, which there is not a great fix for. Well, not that there is always a great fix for immune system inflammatory pain, but I have seen that some of you have had peripheral relief from DMARDS and TNF's, so I was hoping that might be an option for my situation. But even NSAIDs don't really help with the hypermobility stuff. After the doctor did the range of motion test on my knees, my knees and shins hurt a lot more for several days, so it doesn't take much to increase my pain quite a bit.

I am going to go to PT for exercises to strengthen the muscles around my knees, but I don't know how much it is going to help and I don't know of anything that will help my ankles. I jumped and cried out when the doctor grasped my ankle to rotate my knee. And he wasn't pressing that hard. I do a fairly good job of blocking the ankle and shin pain unless someone or something touches it, but I worry about long term damage. And this doctor is not an expert on hypermobility. And I don't know how to find one that is. So that is why I am depressed about the whole thing. The orthotics that I have been wearing for a year have helped some, but the pain and tenderness is always there.

The other thing is that most of the exercises for knees that I know of also aggravate the ischial bursitis. And since mine has been untreated for about 20 years, I've read that the prognosis for a full recovery from that is not good. And running, walking, jumping, squats, and many other strength training exercises aggravate it. I'm hoping that the person giving me PT will have some good solutions, but I never know what I will get. So I feel kind of stuck for now.

Brenda
_________________________
Brenda

undifferentiated spondyloarthropy, HLA-B27+, iritis, naproxen 500 mg, 2x/day, trochanter bursitis, Joint Hypermobility Syndrome, migraines, SI joint dysfunction/hypermobility, DDD L4/L5 and L3/L4, straightening of cervical spine, diabetes, sleep apnea.

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