This topic contains 3 replies, has 3 voices, and was last updated by Brian Zelasko, DC July 20, 2020 at 8:48 am.
July 3, 2020 at 1:38 pm #9370
Brian Zelasko, DCParticipant
Has anyone had any cases involving Bertolotti Syndrome?
19 yo Female with chronic (5 years) right lower lumbar pain radiating into right posterior hip.
Bertolotti additional joint located on left side, demonstrated on MRI.
Sym Int: 2-8 out of 10 depending on time of day and activities
Prov: prolonged sitting, prolonged standing, heavy lifting (tubs of ice cream at work), worse end of the day
Pall: lying down, mornings are better, traditional chiropractic care
QLF 11222 80%
All other Lsp/Hip tests 90% or better.
Lunge Test: unstable, knee adduction bilaterally, toe landing and toe off – the kind of lunge that makes you stop them immediately.
Plan of attache is improving QLF by reducing adhesions present, and progress through multiple steps of rehab starting with the Hip lift, moving to Goodmornings, and eventually Split Squats/lunges.
Just curious if the unilateral aspect of this L5 Transitional Vertebrae will require additional management.
Any feedback would be greatly apprecaited!
Thanks and I hope you all are staying healthy!
Have a great 4th of July!July 6, 2020 at 11:35 am #9371
Keith Puri, DCParticipant
I’ve treated a few patients with Bertolotti Syndrome. Just before the pandemic hit I was treating a 17-year-old female ballet dancer with a 2-year hx of S/S. MRI confirmed Bertolotti Syndrome with a transitional lumbosacral segment and pseudo joint. Similar symptom profile with an added biopsychosocial layer atop of her MSK findings.
I believe the challenge in tx an individual who presents with +ve imaging findings and a dx of Bertolotti Syndrome is not to let that bias you and tx according to the ID principles. Which sounds exactly like you are doing.
I often have to remind myself congenital anomalies that affect MSK biomechanics will likely require long-term load management. The adjacent lumbar segments are already on the fast track towards DJD so ensuring her MSK system is functioning at peak capacity is critical. Lastly, if there is ever a question on whether the transitional segment/joint is the primary pain generator a CT guided intra-articular injection is the “gold-standard”. You just have to make sure the patient is able to find an in-office motion/activity that is provocative to compare pre and post-injection. Ideally, the patient performs the +ve test within ~ 1 hour or so status post-injection for greater reliability.
Looks like you have this covered, good luck!July 9, 2020 at 8:53 am #9374
William Brady, DCParticipant
Interesting case Brian and great response Keith. Definitely don’t get distracted by an anomaly unless it fits with the first order history as a pain generator or limits function determined by the exam. What did your differential diagnostic list look like pre and post exam?July 20, 2020 at 8:48 am #9380
Brian Zelasko, DCParticipant
Sorry for the delay….
Adhesion Lumbar musculature, capsules, cluneal NE
Transitional Vertebrae possible causing uneven loading
Posterior chain weakness
Adhesion: Multifidus (left L4/5 and right L5/S1), Supraspinous lig (L3/4/5/S1), Psoas (Bilateral), Illiacus (Left)
Posterior chain weakness – positive lunge test
Transitional Vertebrae (asymptomatic)
4 tx’s completed, Adhesion has reduced well, as expected, hip lifts have been given.
As of now no signs of complication/symptoms from Transitional Vertebrae.
Patient is improving well, with 0 out of 10 pain on last follow-up.
Perceived Percent improvement 50% – patient has had pain for a long time and it typically comes back, so she is hesitant to admit higher improvement without time to see sustainability of changes, which I completely agree with, but admits she feels much better and is happy with progress.
Side note: Mother is super happy and notices more changes in behavior than the patient (19 daughter).
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