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Diagosis Unknown: An Orthopedic Mystery

For more than a decade, I successfully avoided a visit to the orthopedist for a chronic elbow problem. Today I reluctantly decided, on the advice of a friend and orthopod, to go to the hospital and find out once and for all what could be causing my elbows to lock during certain exercises.

The process took 4 hours, all told. I registered at the clinic, then proceeded to the radiology suite to wait for some X-rays. There was a long line of legitimate-appearing X-ray candidates before me – some in casts, others in slings, still others limping pitifully. I was just fine and pain free, feeling a bit guilty – as if I might be wasting resources.

I glanced at the films as I put them in a folder to take back upstairs to the clinic – they looked perfectly normal. “Oh, boy.” I thought, “young Caucasian female complaining of elbow locking for 15 years, now with normal X-rays.” I bet the orthopedist is going to roll his eyes at me. I was escorted to an examining room where I sat on a table across from my normal X-rays, clipped on a light box.

A trim and athletic gentleman in his mid 60′s introduced himself to me. He had crystal blue eyes and short white hair… and disproportionately large hands (kind of the way Michelangelo’s David does). I was sure that I was the healthiest person he’d see that day. He glanced at my totally uninteresting elbow X-rays, took a deep breath and raised a skeptical eyebrow as he asked me to describe my difficulty.

“Well, when I’m at the gym, my elbows lock at about 15 degrees from full extension during certain exercises. It’s always during the eccentric phase of muscle contraction, and usually during a lat pulldown or seated row. If I rotate my forearm there’s a snap and the discomfort disappears and I can resume the exercise.”

He was impressed by the specificity of my description, and asked me to demonstrate the problem. I felt a little bit silly, but attempted to keep a straight face. Seeing that we were not going to be able to reproduce the problem without counter weight, the good doctor jumped in to simulate the exercise by pulling on my arm. I pulled back, and we soon realized that he was unable to apply a force strong enough to trigger the problem. In fact, I pulled the poor man off balance and nearly dropped him on the floor.

After a few more maneuvers he concluded that he had no idea whatsoever what the problem might be. He told me that since the X-rays were normal there was probably nothing to worry about, and that I might consider avoiding lifting weights in “clanky gyms filled with smelly, sweaty people.”

He dictated his note in front of me, highlighting my excellent health, unusual strength, and completely benign X-rays. He seemed to relish the whimsy of the fact that he was no physical match for me (a smallish blond woman) and added that I was unlikely to be damaging my elbows at the gym.

His advice, as I had anticipated, was to “stop doing the things that trigger the locking” and to consult him if I developed any neuropathic pain or effusions. He added that I reminded him of his daughter.

Well, it was an amusing interaction – but somewhat unsatisfying. It made me think of all the times that I wasn’t sure what was wrong with my patients, and how disappointed they were when I had to tell them this. Medicine is an inexact science at times – and the best that we can do is rule out the really bad stuff, and shrug when the rest remains unclear.

Have you had a problem but couldn’t find a diagnosis? Do tell…This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.


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5 Responses to “Diagosis Unknown: An Orthopedic Mystery”

  1. PearlsAndDreams says:

    Will do … tomorrow, I’m tired right now. Can[‘t think clearly. So it will be after I get home from the hospital.Thanks!

    Pk

  2. PearlsAndDreams says:

    I will still do it.

    We may have found an answer I don’t like.

    Today, just before they discharged mom, the doctor decided that even though mom kept saying her right sided weakness was from post polio, it made the hospitalist uncomfortable. Just to ‘be safe’ a CT scan was ordered.

    She’d had a CT scan a little over a year ago …there was a stroke.

    She told me, this also changes the question of her cause of dementia, with the previous mini strokes … we may be looking at a vascular dementia … and something ‘bodies’ (?) so ..now full neuro work up will once again be done.

    Why is it when we fight hard to find an answer and get one, we don’t want it?

  3. ValJonesMD says:

    Thanks for reporting back, PearlsAndDreams. I’m so sorry that your mom has had a stroke (and potentially more than one – with the vascular dementia diagnosis looming). This would explain her symptoms… Let me know how the work up goes.

  4. drytears says:

    Hi Dr. Val…

    Not sure if you will get this or not but I just found your blog and it’s great! I was making my way through your archives when I found this post… I can really relate to this!

    I had, had headache, horrible headaches that really messed up my life, I was in 24/7 pain for over a year! I saw 3 neurologists, and a nurse practioner in neurology, it was finally the third one at a large teaching hospital who diagnosed and treated me.

    Currently now I am being tossed around trying to diagnosis some shortness of breath, fatigue, cough, and weight gain.

    Of course everything is a bit more complicated with me because I am at school and away from my PCP.

  5. drytears says:

    Hi Dr. Val…

    Not sure if you will get this or not but I just found your blog and it’s great! I was making my way through your archives when I found this post… I can really relate to this!

    I had, had headache, horrible headaches that really messed up my life, I was in 24/7 pain for over a year! I saw 3 neurologists, and a nurse practioner in neurology, it was finally the third one at a large teaching hospital who diagnosed and treated me.

    Currently now I am being tossed around trying to diagnosis some shortness of breath, fatigue, cough, and weight gain.

    Of course everything is a bit more complicated with me because I am at school and away from my PCP.

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