MRI Translation

Two days later, the MRI report appeared on my HMO website test results tab. The technician said it’d be a week or so before my doctor talks to me about it. It was obvious the report was intended for my orthopedist, not for me. It was written in anatomical medicalize, a rarified language. I could have been reading Sanskrit. I’ll just wait, I thought. Then another thought occurred to me: I’m a translator. Give it a go.

“No acute fracture or subluxation. No suspicious osseous lesion.” No dislocation, no bone tumors. Well, thank God. What I do have, apparently, follows.

“Type II accessory navicular with reactive marrow edema in the accessory navicular and medial aspect of the navicular at the level of the marker.” This extra navicular bone on the inner side of the foot comes in several types. Mine is Type II. I didn’t know you could get extra bones, let alone several types of them. Fun etymology: the navicular bone is called that because it’s shaped like a boat. “Navicular” comes from the Latin, whence we get “navy” also. As for its accessory, less than 3% of people are born with it. I should feel special. Like my navicular is a sofa accessorized with a pillow. Except the pillow’s crowding the cartilage and tendons.

The marker: the MRI technician asked me where the pain was and stuck a marker beneath that protruding inside ankle bone. The swelling is at the level of the marker. Well, duh.

On a pre-pandemic walk with Kathleen Cain

“Painful navicular syndrome could have this imaging appearance.” The way that bone looks on the MRI means that yeah, it might hurt. Another fun fact: navicular syndrome in horses leads to serious lameness. Wow, horses have boat-shaped foot bones too.

“Mild tibiotalar osteoarthritis with full-thickness medial chondral fissuring and underlying medial talar dome subchondral cystic change and degenerative reactive marrow edema.” That sentence scared me. I understood no part of it. My initial translation: my foot is going to fall off. Let’s give it another try.

Mild ankle arthritis. “Tibiotalar” refers to the ankle joint connecting foot to leg. “Chondral” is cartilage, “fissuring” is cracking or crevices and “full-thickness” means cracking all the way to the bone. (That can’t be good.) Underlying that, the inside upper part of the foot bone has a fluid-filled space inside the joint (also caused by arthritis) and degenerative swelling. Apparently, swelling happens when fluid builds up in the bone marrow as a response to arthritis.

Putting it all together, Phil suggests: Mild arthritis in the ankle joint with cartilage tears through to the bone, along with fluid buildup in the upper foot joint and swelling in the bone marrow. Medial means inside or middle and edema is swelling. Why don’t they just say so?

Phil is helpful on this point also. “Medial,” he says, running a hand down the middle of his body. “Doctors think of us as fish. The back is dorsal, after all.”

“No ankle joint effusion. No discrete intra-articular body.” If I don’t have those conditions, I’m not looking them up.

I take it back. “Effusion” is a great word: giving off, emitting something like gas or light; an outpouring, current, rush or gush. I imagine my ankle joint pulsating with golden light, but I don’t think that’s what they mean I don’t have.

“Mild third TMT osteoarthritis with minimal degenerative reactive marrow edema.”  TMTs are tarsometatarsals, and of course they’re known as TMTs, because six syllables are too many to say on a regular basis. TMTs are joints in the middle of the foot. They connect things, like toes. The third TMT has some fluid swelling in the marrow.

“No acute ligamentous injury.” The ligaments connect bones together and support our joints. No serious injury to those.

“No other degenerative abnormality.” There’s a sweeping statement. At my age who knows how many degenerative abnormalities I have.

“Very mild insertional posterior tibialis tendinosis.” Pain and/or inflammation around the inside of the foot, the instep/arch and the inside of the ankle. Insertional means at the point where the Achilles tendon inserts (get it?) into the heel bone. But only in a very mild way.

The only thing that hurts routinely is that inside ankle area where the extra bone only 3% of people have lies under the boat bone. The ball of the foot is chronically stiff but doesn’t hurt. I’m still not clear as to whether that’s due to the full-thickness fissuring or the arthritis. Nor do I yet know what to do about any of it.

Getting old is a mystifying journey.

“Ligaments: Unremarkable. Sinus tarsi and plantar fascia unremarkable.”  I beg your pardon.

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