Exit forum › ID Forum Discussion › Patient with significant chronic ache/pain at R TL junction. › Reply To: Patient with significant chronic ache/pain at R TL junction.
Carl Nottoli, DC
Sounds to me like this dude has bad discs. The questions are how bad, at how many levels, how much facet arthritis is also present, and how healthy is the actual vertebrae.
SLPF that needs support to return to neutral with pain is pathognomonic for disc inflammation. KHE can also be painful with disc inflammation and actively inflamed facet arthritis.
Don’t get distracted by the diaphragm or the weird clunk right now. You need eyes on the images as all signs point to structural pathology.
In addition, your DDX should be after the consultation so you can purpose build your examination. After the examination, you should have a complete diagnosis that’s reverse compatible. Use the diagnostic sheet. This will help in difficult cases like this.