$Unique_ID{BRK01566}
$Pretitle{Musculoskeletal System and Connective Tissue}
$Title{No Diagnosis for Constant Knee Pain}
$Subject{knee pain causes}
$Volume{M-17}
$Log{}

Copyright (c) 1991   Tribune Media Services, Inc.


No Diagnosis for Constant Knee Pain


------------------------------------------------------------------------------

QUESTION:  I don't know that you can help me with my problem, but I guess it
is worth a try.  I am a 49 year old man, work as a shoe salesman, and belong
to a weekend baseball team.  For the last several weeks I have been bothered
with a constant pain in my left knee that just won't quit.  I have been to
several physicians now including a specialist, but despite x-rays and
laboratory test galore, no one has yet come up with a diagnosis.  Do you have
any idea what it might be, or what other areas I might explore?

------------------------------------------------------------------------------

ANSWER:  Questions like yours are always a challenge, and most difficult to
answer.  All I can do is to run down all the things I would do if I were your
doctor.  To start with, I would need a much more detailed history to begin my
evaluation, and maybe your doctors do as well.  I want to know everything
about your problem, when does it start, how long does the pain last, does it
keep you awake at night, what makes it get worse, does it ever feel like it
might "give out, and much, much more.  Try keeping a complete diary, noting
down everything that may have anything to do with the pain.  I even need more
information about your activities.  Do you kneel frequently when you are
selling shoes, perhaps banging your knee to the ground in a rush to help your
customer? What position do you play on your baseball team, perhaps a catcher,
who spends long periods in an extreme bending position?  Once past a detailed
history, I am going to examine more than just your knee.  The problem may lie
in your hip, your ankle or foot, or even your back.  All deserve some
attention.  Let's take a good look at how you walk.  Does this gait change
when you have pain, or when the pain goes away?  I want a close look at your
shoes, the one's you wear for work, as well as those you use on the ball
field.  Is there any sign of unusual wear?  How is the fit?  Check the insides
carefully for protruding nails or uneven or worn linings.
     There are also an number of manoeuver I am going to use during your
physical examination, to test the mobility, stability and flexibility of all
the joints in both legs.  I am going to examine the circulation in your leg,
by checking for pulses in the groin, behind the knee and in the ankle or foot.
You will also have a thorough examination of the nerves that run down your
leg.  I would want to check those lab findings as well, and perhaps order one
or two tests that may have been overlooked (There is always "just one more
test" that can be useful!) Now while we are waiting for those tests to come
back, I would do two things.  Review all your previous x-rays, and put you on
a "limited activity" routine.  It is amazing how many symptoms disappear when
we give our bodies the rest they need and the opportunity to do a little self
repair.  I may also prescribe some medicine for pain, and would want you to
report back on its ability to stop the pain or change its severity or pattern
of occurrence.
     When all of this is said and done, we will face three possibilities.  The
first and most desirable outcome, is that the pain will have disappeared even
though we never found the cause.  You would be surprised at how often this may
happen.  Number 2; we will have come up with a diagnosis and a reasonable
explanation for your pain.  That will lead to the appropriate treatment.
Last, I come up wanting, no diagnosis and the pain continues.  Then it is time
for referral, and I would choose a specialist in sports medicine, just on a
hunch.
ÿ
----------------

The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
