A 28-year-old man named Eric consulted an MSR-supported physiatrist when he experienced a burning pain in his left knee. He noted that his pain came on acutely when he was bent forward trying to lift a box. It started approximately a week before visiting the physician.
Eric had no relevant past medical history and no prior low back pain. He noticed pain in his left knee with burning, worsening with bending forward and lifting. Further questioning from the physiatrist indicated that Eric did experience low back pain, which was also left-sided.
X-ray revealed no acute fractures and no arthritic changes, so the physiatrist started Eric on a physical therapy program. After a course of therapy, Eric noticed some improvements, but he still had ongoing left knee pain with burning, with low back pain, left-sided. The left knee joint itself was nontender and pain free.
The physiatrist ordered an MRI of the lumbar spine that revealed a disc herniation at the L2-3 and L3-4 levels radiculopathy, so he put Eric on a lumbar traction machine that relieved his left knee burning.
Eric recovered fairly well after approximately 3-4 months of physical therapy in total. The physiatrist diagnosed him with lumbar disc herniations with a left L3-4 radiculopathy, which was the cause of the patient's burning around the left knee region.
It was important that Eric sought attention from a PM&R specialist, as one of the areas of specialty for a physiatrist is musculoskeletal medicine dealing with lumbar disc herniations, radiculopathies, as well as pain from knee joints and other joints. Often a patient is misdiagnosed with left knee internal derangement. A patient may even undergo a procedure to the left knee mistakenly. Unless a diagnosis of lumbosacral radiculopathy is known and is looked for, it will not be determined and treated properly.
Upon discharge, Eric reported significant improvements. He did notice some residual weakness in the left lower extremity. However, the pain had subsided significantly and was exacerbated only with prolonged sitting.
The ability of a specialist in Physical Medicine and Rehabilitation (PM&R) to provide multidisciplinary and multimodal care, as well as the ability to focus on patient function and the patient as a whole separates the physiatrist from other medical specialties. It is what makes the physiatrist a unique provider of medical care.
Case study by Gautam Khakhar, M.D., FAAPMR
Physical Medicine and Rehabilitation of NY, PC