Patients Presenting Concern:
A few years ago I had college basketball player come and see me for numbness and pain of her lower legs. It was excruciating at times and was starting to cause her to miss practices and games. Being a college athlete is hard enough without having to deal with a serious injury. Athletes become very stressed out when they are potentially looking at having to be side-lined. Not only is their team relying on them but they have a responsibility to play due to often being on scholarship.
When I first saw her I knew that it was a severe problems that needed to be figured out ASAP. I was concerned about potential serious long-term complications if not “fixed” in a timely manner. I felt this was a condition called compartment syndrome. Because the symptoms had been going on for months prior, I felt this was the chronic rather than acute compartment syndrome. I had gone to a sports medicine conference within the past year that reviewed this exact condition. This is a condition in which increased tissue pressure within the fascia compartment compromises blood flow to the muscles and nerves, with potential for damage/disability.
I reviewed this with an orthopedist doctor who felt that it was unlikely (due to it being uncommon) but he would take a look at her. He ended up ordering multiple tests, which all came back normal. Then weeks later her symptoms became significantly worst. She came and saw me. I called another orthopedic doctor who rudely agreed to see the patient at the ER. After evaluating the patient and reviewing with 2 other doctors he felt that it was not an orthopedic problem and literally said that he did not want to deal with it again in the future. He referred her to another specialist, and that work up was inconclusive.
She came to see me again. This time I called the original orthopedic doctor that saw her and explained that I really felt that it was this chronic compartment syndrome. He agreed to do a pressure test for this, and low and behold it came back abnormal. She then was scheduled for a surgery called a fasciotomy on both legs to relieve the pressure. As soon as she got out of surgery and the anesthesia wore off her symptoms went away and the condition was cured.
The moral of the story is that in family practice you really have to be persistent and advocate for the patient.