Q: My wife is in her late 50s. A little more than a year ago she began to have pain in her right leg. It does not always occur in the same location in the leg and is most prevalent in the upper area, usually to the outside or back portion. The pain will worsen with activity and just standing will also make it worse. The pain has and does affect her daily life, some days more than others. She is normally very tolerant of pain. She doesn’t have a structured exercise program but is normally very active.
She went to our family doctor who had X-rays taken of her leg, which didn’t reveal anything. She tried physical therapy but after not seeing results in a few sessions, she stopped. She had a slew of exercises to try, again stopping after not getting the expected results. After the X-rays but before an MRI, I suggested she see an orthopedist but she said he deals with bones and the X-rays showed no issue with the bones. I was under the impression an orthopedist deals with muscles, bones and other connective tissue. I still would like her to see either an orthopedist or a neurologist.
This is affecting her quality of life and she is losing patience, hope and faith. We are both retired now and many of the things we would like to do together involve physical activity. I am truly hoping you can help, or suggest someone who can. She is far too young to feel as old as she says this is making her feel. HELP, PLEASE! Thank you in advance.
A: To begin with, an orthopedic physician is one who utilizes surgical and non-surgical means to treat sports injuries, degenerative disorders, infection, musculoskeletal trauma, and a great deal more. You are correct in that the specialty deals with the prevention or correction of injuries and disorders of the skeletal system, associated muscles, joints, tendons and ligaments. She has already seen her physician, had X-rays, physical therapy, and exercised without relief. What harm could a new set of eyes from a physician in an appropriate field do?
A neurologist is involved with the study and treatment of disorders that involve the nervous system, brain, spinal cord and nerves. Individuals in the field treat movement disorders such as nerve diseases of the extremities (such as peripheral neuropathy, Parkinson’s, spinal cord issues, neurodegenerative disorders such as Alzheimer’s, ALS and others. Neurologists do not perform surgery. I feel you are closer on the mark with your wife initially seeing an orthopedist than a neurologist. Should one be appropriate, you can always make an appointment with someone in that field, as well.
Most leg pain is the result of overuse, an injury to the bones, muscles, ligaments, tendons, or other soft tissues. Some issues can even be traced to problems of the lower spine. Other possibilities that come to mind include poor circulation, blood clots, or varicose veins.
Non-traumatic leg pain in a joint may carry a diagnosis of peripheral artery disease, a decrease in the arterial blood supply to the leg because of narrowed blood vessels. The pain may come on with activity, a period when additional oxygen is demanded by the muscles. With narrowed arteries, the demand cannot be met, and the surrounding muscles may ache. Also, pain may result from nerve impingement, diabetes, an electrolyte imbalance, failure to stretch prior to exercise, dehydration, or specific prescribed medications.
I recommend your wife make an appointment with an orthopedist who may choose to order nerve conduction testing (to evaluate nerve function), an arteriogram (to check the arterial supply to the legs), or even joint aspiration (to rule out infection) to help with a diagnosis. Treatment will depend on the diagnosis so she can hopefully eradicate or at least reduce her level of pain and allow her quality of life to improve.
