Do Rheumatologists and Orthopedists Interpret X-rays Differently?

Q: Do Rheumatologists and Orthopedists Interpret X-rays Differently?

Hello, thank you for your question. <br>Here are my responses： <br>1) Can a general rheumatologist identify signs of a mild spinal arch fracture on an X-ray? (Isn't it more likely for an orthopedic surgeon to interpret bone X-rays?) --> I believe both specialties can, as well as

Is there a difference between a rheumatologist and an orthopedic surgeon when interpreting bone X-rays?

Dear Dr.
Gao,
I am a patient with ankylosing spondylitis.
Recently, I have developed pain in my lower back when leaning backward, but I do not experience pain when bending forward.
I have been receiving treatment for ankylosing spondylitis.
A few days ago, when I consulted with you, you mentioned that this symptom does not resemble the typical symptoms of ankylosing spondylitis and suggested that I see a neurosurgeon.
I then recalled that I had a motorcycle accident six months ago before the pain started, but I did not think it was serious at the time, and the back pain began more than a month after the accident, so I did not connect it to the fall.
Next Wednesday, I will return for my regular three-month follow-up appointment with my ankylosing spondylitis specialist, and I may undergo X-rays.
I have done some research online and suspect that I might have a spinal arch fracture or something similar, but it may not be severe since I only experience pain when leaning backward, and I do not have pain when bending forward (I also do not have any symptoms like pain or numbness in my hips or legs, and I can run, play badminton, and sit for long periods without pain, and tapping my back does not cause pain).
I would like to ask you the following questions:
1) Can a rheumatologist generally identify signs of a mild spinal arch fracture on X-rays? (Is it more likely that an orthopedic surgeon would be better at interpreting bone X-rays?)
2) If I do have a spinal arch fracture, would my symptoms be considered mild, and should I not worry about the possibility of surgery at this point?
Thank you, Doctor.

Jie, 10~19 year old female. Ask Date: 2022/11/12

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses:
1) Can a general rheumatologist identify signs of a mild spinal arch fracture on an X-ray? (Isn't it more likely for an orthopedic surgeon to interpret bone X-rays?) --> I believe both specialties can, as well as neurosurgeons.
However, if you are looking to rule out the possibility of trauma, it would be more efficient to consult an orthopedic surgeon or a neurosurgeon.
2) If I have a spinal arch fracture, do my symptoms indicate that it is mild, and can I avoid worrying about surgery for now? --> While the symptoms may be mild, considering your young age, the duration of pain (six months) is somewhat prolonged.
Therefore, I recommend that you see a neurosurgeon or orthopedic surgeon for further evaluation.
Early detection and intervention can reduce the risk of future complications.
The solution may not necessarily be surgery; it could also involve medication or rehabilitation.
It’s best to hear the physician's opinion first.

Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2022/11/12

More Info

When it comes to interpreting X-rays, both Rheumatologists and Orthopedists have their unique perspectives and areas of expertise. While both specialties can analyze X-rays, their focus and training may lead to different interpretations, particularly in cases involving musculoskeletal disorders.

1. Can Rheumatologists Identify Signs of Mild Spinal Fractures on X-rays?
Rheumatologists are trained to evaluate X-rays, especially in the context of inflammatory and autoimmune conditions like ankylosing spondylitis (AS), which you mentioned you have. They can identify changes in bone structure, joint spaces, and signs of inflammation. However, Orthopedists typically have more extensive training in evaluating skeletal injuries, including fractures. They are often more adept at recognizing subtle fractures or structural abnormalities, such as a spinal arch fracture, due to their focus on surgical interventions and trauma care. In your case, if there is a suspicion of a spinal fracture, it would be prudent to consult an Orthopedist or a Neurosurgeon, as they can provide a more detailed assessment of the bone integrity and recommend appropriate imaging or treatment.

2. If I Have a Spinal Fracture, Are My Symptoms Considered Mild, and Should I Worry About Surgery?
Your symptoms, which include pain only when arching your back and no other significant discomfort during activities, suggest that if there is a fracture, it may not be severe. However, the duration of your pain (six months) is concerning. Even if the symptoms seem mild, it is essential to consider the potential for complications or worsening of the condition. Spinal fractures, even if they appear minor, can lead to instability or chronic pain if not managed appropriately.
Surgical intervention is not always necessary for spinal fractures. Many cases can be managed conservatively with physical therapy, pain management, and monitoring. The decision for surgery typically depends on several factors, including the type and location of the fracture, the degree of instability, and the presence of neurological symptoms. Since you have been experiencing pain for an extended period, it is crucial to have a thorough evaluation by a specialist who can determine the best course of action.

In summary, while both Rheumatologists and Orthopedists can interpret X-rays, Orthopedists may have a more refined ability to identify fractures due to their surgical training. If you suspect a spinal fracture, it is advisable to seek an evaluation from an Orthopedic specialist or a Neurosurgeon. They can provide a comprehensive assessment and discuss potential treatment options, which may include conservative management or, in some cases, surgical intervention. Always prioritize open communication with your healthcare providers about your symptoms and concerns to ensure you receive the best possible care.

Similar Q&A

Understanding X-ray Discrepancies in Sacroiliitis Diagnosis

First, I would like to thank the doctor for the response. As the doctor mentioned, serum tests are only a reference. I am more concerned about the X-ray findings. Although inflammation may not always be persistent, the damage caused by sacroiliac joint inflammation is permanent. ...

Dr. Gao Jiankai reply Internal Medicine
Hello Mr. Lu, thank you for your question. The sacroiliac joint appears irregular on X-rays, making it challenging to determine the presence of arthritis, as there can be discrepancies in grading. As for which hospital's X-ray results are more reliable, there are many influe...

Understanding Health Insurance X-Ray Regulations for Orthopedic Issues

Recently, I have been experiencing tibial pain that has spread to my knee for nearly a month. I finally found a clinic with X-ray services, but I was told it was just fascia inflammation. However, my bones really hurt! Is it true that health insurance only covers X-rays for fract...

Dr. Shi Guozheng reply Orthopedics
If the disease treatment is not effective, and based on the physician's assessment, X-rays can be taken if there are indications. Fractures and arthritis are the most common conditions for which X-rays are routinely performed.

Understanding X-Ray Types for Back Pain: Standing vs. Lying Down

Hello, Doctor Shi: Recently, I've been experiencing frequent lower back pain, so I would like to get an X-ray to check it out. I understand there are two types of X-ray positions: standing and lying down. Is there a difference in the results? Which one is more accurate? Shou...

Dr. Shi Guozheng reply Orthopedics
Lower back pain can be evaluated by an orthopedic specialist. Whether or not an X-ray is needed will be determined after a physician's assessment. There are various methods for obtaining X-rays, and the best one depends on the specific purpose. Generally, the images are quit...

Understanding the Differences Between Orthopedic and Thoracic X-rays

Hello, my son is currently 12 years old. One side of his sternum is flat while the other side is elevated, and the elevated side's nipple is also larger. We visited an orthopedic doctor and had an X-ray taken, but the doctor said there is no issue with the bones; it might be...

Dr. Wang Yifen reply Radiology
I apologize for the late response as I just saw your question. A chest X-ray will not differ based on the requesting unit. An orthopedic physician focuses on the evaluation of bones, while a pulmonologist concentrates on lung diseases. If a child has developmental abnormalities, ...