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Old 18-01-2008, 03:47 AM   #1
pht3k
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Default fascia separation

hi,

the other day i saw a picture on the web of a pathology where the fascia over the buttocks were separed (this is not the right term but cant find better in english). the space between muscle and fascia was filled with liquid. it looked like a huge bump. i have a patient here with something that looks similiar. the doctors just dont care about it. and i would like to check at the webpage but i forgot to bookmark it... and cant remember the name of the patho.. was a strange name. someone have an idea what can be the pathology name???
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Old 18-01-2008, 04:18 AM   #2
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Dercum's disease?
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Old 18-01-2008, 05:26 AM   #3
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dercum disease is fatty deposis.

i am referring to liquid accumulation between fascia and muscle.
the patient i am referring to is having a liquid mass over the L5-S1 area, approx 2x3 inches area, near 1 inch width, and the liquid is really liquid as water, not visquous. i can push on it and liquid is moving around easily. i could not see if it is changing size from time to time yet. but she mention that some day it is bigger. i am wondering if this might be the patho i saw last week and cant remember the name.

lumbar pain 15/10 since a year. her movements fit the pain level. saw her maybe 5 times yet. huge left sacro-iliac laxity. so i teach her for the moment about pain, i suggested a sacro-iliac belt, gentle core exercices, feldenkreis ex's, and breathing ex's. she now can sit 15 minutes in a row, compared to 5 minute at the begining of the treatment.

i am not sure how this liquid mass might have something to do with her pain state. the physician just said: it's inflamation and did nothing about it. inflamation? no coloration, no heat, ... just liquid.

btw is there necessary headache with low level of CSF?? maybe there is a CSF breach?

how can there be so much liquid there anyway?? very poor lymphatic drainage?

your thoughts?
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Last edited by pht3k; 18-01-2008 at 05:29 AM.
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Old 18-01-2008, 06:30 AM   #4
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Maybe you can retrace your steps pht3k, and find the picture again...bring it here.
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Old 18-01-2008, 06:41 AM   #5
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pht3k,

Over the years I have noticed unilateral small swellings on some patients around the paraspinals - usually one per patient, LBP was present and had been for some weeks. The swelling was very soft and malleable and about the size you mentioned; no tenderness unless the fluid was pushed a bit too firmly, and that would have been more skin pressure than anything. Definitely fluid...but I don't think it could be CSF.

Other PTs noticed the same sort of thing, but nobody took any further notice.
I do remember that when the back pain resolved, or improved considerably, the swelling dissipated.

Bit of a mystery.

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Old 18-01-2008, 09:45 AM   #6
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I think its lymph fluid not circulating proper. I noticed this as well with LBP that the sacrum area is a bit puffy.
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Old 18-01-2008, 10:58 AM   #7
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Quote:
Originally Posted by Baecker View Post
I noticed this as well with LBP that the sacrum area is a bit puffy.
I agree with you Baecker, I have noticed the same in some of my patients,
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Old 18-01-2008, 01:41 PM   #8
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Quote:
I noticed this as well with LBP that the sacrum area is a bit puffy.
I've seen that many times also.
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Old 18-01-2008, 01:48 PM   #9
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Quote:
I noticed this as well with LBP that the sacrum area is a bit puffy.
This is one of those clinical things that I'm no good at all. Especially with axial swelling where there is no side to side comparison to be made. Also, since we see the numerator in the clinic I can't even compare to the denominator without risking some sort of harassment accusation.

If the swelling is "a bit" or someone needs to ask if something is swollen in the first place (because it is insufficiently obvious) it is likely that I'll have no useful information to add.

My question is, is this something that is sufficiently important that I should work on improving this skill? What does it mean and will it change my treatment or advice?
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Old 18-01-2008, 03:12 PM   #10
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Quote:
Originally Posted by Baecker View Post
I noticed this as well with LBP that the sacrum area is a bit puffy.
I've noticed this puffiness as well over the sacrum and over the paraspinals. I had a new client yesterday who presented with this. She's been diagnosed with stenosis, lumbar disc herniations, trochanteric bursitis, and hypertonic hamstrings. Hamstrings were recalcitrant to my techniques (I even tried my best approximation of amateur DNM). I'm thinking lumbar radiculopathy. Come to think of it, all of the lumbar radiculopathy cases I've seen have had some degree of puffiness.
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Old 18-01-2008, 04:20 PM   #11
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Some people, mostly women, seem to have puffiness over the sacrum. I've never seen this decrease with any sort of treatment.

I stopped worrying about it and starting focusing on nerves and pain instead. I think it's probably just a genetic variation - morphologic, not pathologic. Plus, lots of people with flat bony sacrums have pain too, so I don't think we can blame the puffiness over some sacrums for pain - it could well be they are two completly separate issues, not associated in any way.
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Old 18-01-2008, 04:56 PM   #12
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Jon Newman said: If the swelling is "a bit" or someone needs to ask if something is swollen in the first place (because it is insufficiently obvious) it is likely that I'll have no useful information to add.

Baecker said: I noticed this as well with LBP that the sacrum area is a bit puffy.

Both affirmation looks true to me.

But i asked here because with this woman the swelling is not just a bit... One inch width is a lot to me, much more than what i am used to see usually. And like Jon said, people frequently say that there is swelling but i usually dont care about it since it is insufficiently obvious and what people interpret as swolling is often muscular tension.
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Old 18-01-2008, 05:46 PM   #13
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Quote:
One inch width is a lot to me, much more than what i am used to see usually.
Yes it can seem really huge, especially to manual therapy eyes trained to be sensitive to vanishingly small abnormalities. Yet I still maintain that some people are likely just built that way, and we see it rarely enough that its presence in someone (usually female) seems a big deal, like maybe a "sign" of something or other.
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Old 18-01-2008, 06:19 PM   #14
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okay,
thanks.
and if i can find again the patho/picture i was looking for i'll post it for your information. in this patho the swelling was not over L5-S1 area but over all the gluteus maximus area.
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