Suggest Treatment For Acute Joint Pain
Question: I’m a 22 year old in the USA with a problem no doctor seems able to diagnose. I have been healthy all my life, eat a standard diet and have no family medical history. In high school I was very active and played on several sports teams but over the past five years I have had an increasing number of pain problems with my “joints”. It began with my knees when I stood for hours behind an ice cream counter in high school, and now includes my ankles, jaw, elbows, and wrists. This has made me unable to perform nearly all exercises including low impact swimming and even walking. After minimal exercise, such as a two hour hike, my ankles will have a low level constant ache for days. They hurt every day. I have been to a total of six doctors including a rheumatologist, orthopedic surgeon, and an orthopedic sports medicine doctor, and two physical therapists. In physical therapy, the furthest they were able to get me was resistance bands. All the obvious things have been tested for and come up negative, from Lyme disease to arthritis to any sort of infection or inflammation. No doctor has any suggestion now of what I might do to resolve this and the last group stopped without any diagnosis they could name or suggestion of whom I might go to see. Last thing I did with them was a three phase bone/joint scan with radioactive tracer. The doctors found anomalies where I had complained of pain. They said my scan looked similar to that of a marathon runner or someone who currently engaged in intense physical activities, but I have only sat a lot for the last few years. There were no signs of an inflammatory joint disease such as rheumatoid arthritis. I was told the findings are “more suggestive of stress reactive changes on the bones where tendons and ligaments attach”. As the official report said, “There was no evidence of an inflammatory arthropathy to joints. There are stress reactive changes to elbows and wrists and stress related periosteal reactions in mid right foot and in the bilateral tibial tuberosites.” Unfortunately they offered no solutions to my problem besides pain management medication, and every doctor has said they have never seen a similar condition. This issue has really taken a toll on my life, as I have seen myself go from a physically fit individual to being inactive and overweight. I was hoping for some guidance or suggestions as to what the problem is and how I can go about making myself better. Is there a nutrition related component I should pursue? If I go to another orthopedic (?) doctor what should they be looking for? What sort of specialty should I pursue? Have you ever heard of this injury w/o exercise? Report is uploaded to this site.
Brief Answer:
You need evaluation for BJHS.
Detailed Answer:
Dear Sir,
Thank you for posting your query on HCM.
Well looking into your problem I would like to tell you that going through your entire history, there seems to be a possibility of Benign joint hypermobility syndrome . Have you been evaluated for the same. Further advise will depend on the fact whether this diagnosis has been excluded or not .
So please let me know about the same.
Take care.
Dr. Shruti
You need evaluation for BJHS.
Detailed Answer:
Dear Sir,
Thank you for posting your query on HCM.
Well looking into your problem I would like to tell you that going through your entire history, there seems to be a possibility of Benign joint hypermobility syndrome . Have you been evaluated for the same. Further advise will depend on the fact whether this diagnosis has been excluded or not .
So please let me know about the same.
Take care.
Dr. Shruti
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
That is possible. Another doctor that saw me said I had this slightly. I am thinking that is a separate issue. I did not get this way after lack of exercise. I was a high school athlete. There was plenty of support at joints when pain first started. Also I am wondering if the results of the bone scan are in keeping with hypermobilty. I was told the findings were “more suggestive of stress reactive changes on the bones where tendons and ligaments attach”. As the official report said, “There was no evidence of an inflammatory arthropathy to joints. There are stress reactive changes to elbows and wrists and stress related periosteal reactions in mid right foot and in the bilateral tibial tuberosites. Also I went to a physical therapist and worked on strengthening and quickly reached a point where pain was to great to continue. Can you think of something else. I have also tried working with a nutritionist and done yoga weekly but not improvement so far.
Brief Answer:
Follows.
Detailed Answer:
Dear Sir,
BJHS happens to be the most probable diagnosis , and yes bone scan can show abnormalities in such patients . Since the mobility in joints is not restricted they are more prone for stress reactions.
In my opinion this has is the most likely diagnosis in your case. Any other query please let me know.Plus I will advise you to restrict very strenuous and high impact exercises as it will aggravate the problem further.
Dr. Shruti
Follows.
Detailed Answer:
Dear Sir,
BJHS happens to be the most probable diagnosis , and yes bone scan can show abnormalities in such patients . Since the mobility in joints is not restricted they are more prone for stress reactions.
In my opinion this has is the most likely diagnosis in your case. Any other query please let me know.Plus I will advise you to restrict very strenuous and high impact exercises as it will aggravate the problem further.
Dr. Shruti
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Above answer was peer-reviewed by :
Dr. Prasad