Word: paines
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...little shaken, he finally established that about a month earlier he was standing in his office, having just come up a flight of stairs, when he felt a sudden pain and a bit of a pop in his right calf. The calf was sore and it made him limp so he went to a commercial chain's urgent care center nearby (a "doc-in-the-box" in hospitalese) and thus began his saga. The story made me groan...
...What Tim had, at least by his history, was a true classic - a common problem. His physical exam was also classic - tender at a certain spot on the inside of the calf, pain here when he tried to stand on tip toe. It's called "tennis leg" because it often happens on the tennis court; it feels like you just got hit with a ball. In the days before MRI we thought it was caused by rupture of an unimportant little muscle in the leg called the plantaris. Now we know it's actually a small tear of a part...
...Consider first the vascular test: All orthopedic surgeons have a great respect for phlebitis. Thrombosis (clotting) in the big veins of the legs is among the top killers of orthopedic patients. And calf pain is one of the signs. I never faulted anyone for getting a Doppler, the test for the blood clots. I have seen patients with barely any calf pain at all fall over dead from the things - you can't be too careful. A recent scare about Vice President Dick Cheney's calf clots showed how seriously doctors take them. Tim was a little tender (albeit...
...Then there were the MRIs of his lumbar spine: Here the docs-in-the-box might have been simply playing the odds. Patients who complain of leg pains often turn out to have what we call radiculopathy, which affects the spinal nerve roots. Sciatica is a well-known term for one type of this. Although caused by pressure on a nerve in the back, there might be very little or no back pain. Patients sometimes just cannot believe there is nothing wrong in their leg. Tim could have been vague about his story, or he might have been so wound...
...justified as well considering the weakness - or what seemed like weakness - of Tim's calf muscle. These rather unpleasant examinations measure the electrical activity in nerve and muscle. The torn calf muscle would hurt to use and so would appear weak. And its reflex would be inhibited by the pain and swelling, further implicating a nerve issue. Certainly one could justify these tests as well by the findings on Tim's exam. Right...