Which Specialist Should Your Friend See for Persistent Leg Pain?

Which specialty should I consult for this symptom?

Hello: First, let me tell you about my friend's symptoms: 1.
He has persistent thigh pain (the pain extends from the thigh down to the knee).
2.
He cannot sit because the thigh becomes sore, tingling, and painful.
3.
He can walk, but he has a limp; at least the pain while walking is not as uncomfortable as when sitting, but lying down is even more comfortable (could it be possible that a nerve is being compressed?).
4.
Before the leg pain, he experienced lower back pain that prevented him from sitting (the onset of the leg pain was less than one or two months apart).
5.
He is a freight driver and has been in this job for 1.5 years; he is 25 years old this year.
6.
The pain is in his right leg, which was broken in a major car accident about 10 years ago, and since then, he has not eaten bananas (this was the doctor's recommendation at that time).
7.
He visited an orthopedic doctor for his leg pain and was prescribed only three medications: one for gastric protection, one pain reliever, and another one that he forgot the name of, but it was specifically for muscle relaxation, which causes drowsiness (it was noted on the prescription, so he can only take it at night).
However, when he wakes up the next morning, that leg is extremely sore, and the situation is very severe.
8.
The doctor said that the medication is meant to relax his muscles, indicating that his muscles are too tight, but based on my understanding, it seems to be more complicated than that.
Otherwise, why is there still no effectiveness? I would like to ask: since the pain is in the injured leg, he went to see an orthopedic doctor, but the medication prescribed makes me feel that he should also see a specialist related to muscles.
If so, which specialty would be more appropriate? Furthermore, based on the above descriptions, can we roughly understand what is happening with his leg? Is it really just a simple injury? Could it be related to his diet? PS: Hmm? I need to choose a physician to answer this question, but I am not very clear on which specialist should address this issue.
If the physician I choose is incorrect, please let me know, and I will resubmit the consultation form to the appropriate specialist.
Thank you! ^^

Qiuqiu, 20~29 year old female. Ask Date: 2004/07/24

Dr. Zhou Lizhi reply Orthopedics

Dear user, thank you for your detailed description of the symptoms.
I will reorganize the issues as follows:
Firstly, the full name of orthopedics is "Orthopedic Surgery," which encompasses issues related to bones, muscles, and joints.
Therefore, the patient's concerns should indeed be directed to an orthopedic specialist.
1.
The patient is 25 years old and has been working as a heavy load driver for 1.5 years.
He had a femur fracture from a car accident ten years ago (he can walk, indicating it has likely healed).
He has a limp, but the pain while walking is less severe than when sitting.
This suggests that it is not a residual effect of the fracture (the pain while walking should be more intense due to the load).

2.
From a Western medical perspective, whether or not the patient eats bananas does not have a direct correlation with fracture healing.
3.
Typically, doctors prescribe three types of medications: pain relievers, anti-inflammatories, and muscle relaxants.
Some muscle relaxants can indeed cause drowsiness, but not all have side effects.
This can be discussed further with the physician.
4.
In summary, based on the symptoms described, I would recommend that the patient be evaluated for possible lumbar nerve compression leading to sciatica and numbness in the affected limb for the following reasons:
- There is a past medical history of back pain that prevented sitting or standing.
- Young individuals may experience herniated discs compressing nerves, causing pain from the thigh to the knee and even the ankle.
- Symptoms may arise from changes in posture that compress nerves.
Therefore, it is advisable for the patient to undergo a detailed examination of the lumbar region to determine if it is the source of the symptoms.
Our facility has reached a mature stage in conducting examinations and spinal surgeries related to the lumbar region.
Thus, I recommend that the patient visit the outpatient clinic for a thorough evaluation.
Thank you for your inquiry.

Reply Date: 2004/07/24

More Info

Based on the symptoms you've described regarding your friend's persistent leg pain, it seems that he may benefit from a multi-faceted approach to diagnosis and treatment. Given his history of a significant leg injury from a car accident, as well as his current symptoms, it would be prudent for him to consult with several specialists to ensure a comprehensive evaluation.

1. Orthopedic Specialist: Since your friend has a history of a leg fracture and is experiencing ongoing pain, starting with an orthopedic surgeon is a logical choice. Orthopedic specialists focus on the musculoskeletal system, which includes bones, muscles, ligaments, and tendons. They can perform imaging studies such as X-rays or MRIs to assess any structural issues that may have arisen from the previous injury or any new conditions that may have developed over time.

2. Physical Medicine and Rehabilitation (PM&R) Specialist: Also known as physiatrists, these specialists focus on restoring function and improving quality of life for patients with physical impairments or disabilities. They can provide a comprehensive assessment of your friend's pain, including its impact on his mobility and daily activities. They may also recommend a tailored rehabilitation program, which could include physical therapy to strengthen the muscles around the knee and improve flexibility, potentially alleviating some of the pain.

3. Neurologist: Given your friend's symptoms of pain radiating from the thigh to the knee and the possibility of nerve involvement (especially considering he has difficulty sitting and experiences a limp), consulting a neurologist could be beneficial. They can evaluate for any nerve compression or damage that may be contributing to his pain. This is particularly relevant since he has a history of back pain, which could indicate that the issue may stem from the lumbar spine affecting the nerves that innervate the leg.

4. Pain Management Specialist: If your friend continues to experience significant pain despite treatment, a pain management specialist could provide additional options. They can offer various interventions such as nerve blocks, epidural steroid injections, or other modalities to help manage chronic pain effectively.

5. Dietitian or Nutritionist: While the primary focus should be on the physical aspects of his pain, it’s also worth considering the role of nutrition in recovery and overall health. A dietitian can help assess his dietary habits and suggest changes that may support his healing process and overall well-being.

In terms of the nature of his pain, it is possible that it could be related to muscle tightness, nerve compression, or even post-traumatic changes in the musculoskeletal structure due to his previous injury. The fact that he experiences relief when lying down suggests that certain positions may alleviate pressure on nerves or muscles, which is a common phenomenon in cases of nerve-related pain.

It is also important to note that psychological factors can play a role in chronic pain. Stress and anxiety can exacerbate pain perception, so addressing any underlying emotional or psychological issues through counseling or therapy may also be beneficial.

In conclusion, your friend should consider seeing an orthopedic specialist first to evaluate any structural issues related to his previous injury. Following that, he may benefit from consultations with a PM&R specialist, neurologist, and possibly a pain management specialist. Additionally, exploring nutritional support could provide a holistic approach to his recovery. It’s crucial for him to communicate openly with his healthcare providers about all his symptoms and concerns to ensure a thorough evaluation and appropriate treatment plan.

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