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Family Medicine  (Expert Forum)
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Undiagnosable Joint Pain
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.

Undiagnosable Joint Pain

by heatherfutral, Nov 19, 2003 12:00AM
I am 24 years old and I have been suffering from pain in my four left fingers since July and in my right thumb for over a year.  I also have TMJ because I grind my teeth in my sleep (I have been seeing a physician for this and it has improved, but I am still in a significant amount of pain). I have been to a hand specialist who told me my thumb was arthritic and gave me a shot of cortizone which did nothing for me. My jaw was also said to be arthritic from an MRI. I went to a Rheumatologist and he said he didnt think I had arthritis because my joints are not red nor swollen. I have also been diagnosed with femeral pattela syndrome because my knees will hurt really bad even if I do minimal excercise. I have been tested negative for RA and ruled out for Lupus. I dont know if it's something I am doing in my sleep (like the TMJ) because I have alot of nightmares and sleep poorly..the pain in my hands and jaw is also worse in the morning. I also am under a lot of stress (from a PhD. program and from a new marriage)...I have a lot of knots in my  back...more than the physical therapist has ever seen who is treating my TMJ. I am wondering if they could be connected. Also, at this point, I dont know what kind of Doctor could be helpful, since the Rheumatolgist and hand specialist both basically said they could do nothing but prescribe and NSAI (which all make me vomit). The only thing that has ever helped was Prednesone (which I was on for a week on time) but I know I cannot continually take that.,,but when I was on it, the pain completely cleared up.  Also, I am doing alot more housework with my hands because of the new marriage. Anyway. I am wondering if you have any ideas what could be the problem and just what type of physician I should see because I'm not really getting treated at this piont and the pain is worsening every month. Thanks.

by Kevin Pho, MD, Nov 20, 2003 12:00AM
If the rheumatologist and the hand specialist referrals were not revealing, you may want to consider the services of a physiatrist (rehabilitation specialist).  They are physicians that will help in the rehabilitation process and may be of assistance in this case.

As an aside, if the prednisone has completely cleared up the pain, you may want to consider obtaining a sedimentation rate.  A rheumatological disease known as polymyalgia rheumatica can cause upper arm, shoulder and back pain.  Prednisone is the treatment for this.  You may want to discuss this with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.
Member Comments

by sbbongi, Jan 30, 2004 12:00AM
During the past three years, I have had erratic pain in my knees and elbows. I had injections of steroids in my elbow twice, once in my knee. One time the injection brought relief.
Now, during the past three months, I have had lower back pain accompanied by muscle spasm.  My doctor treated this with antiimflammatory drugs and muscle relaxants. These worked to a degree, but the pain returned.  When it got debilitating, he gave me Predisolone for 6 days.  It worked like a miracle within 36 hours.  Within two weeks after cessation of prednisolone, the symptoms returned with a vengeance. He referred me to PT, who gave me excercises for a dowager's hump i am forming. Great! My symptoms got worse, and my Doc has referred me to a rheumotologist. I have to wait another 3 weeks to see her.  I was negative on the blood test for immflammtion, but I was on anti immflamitory drugs at the time. Does this matter?  
My symptoms are progressing.. today I cannot lift my arm above my chest without severe pain. We have bought a new bed, I have good shoes ( I cook for a living and am on my feet on a concrete floor all day ) and I feel almost ready to go on disability if i can't find some relief. I am taking vicodin like candy, have hypnotic sleeping pills which don't work for me, and I really don't want to take any pills at all.  I have had no xrays or MRI or Cat Scans. What the heck should I do? I tried to get my appointment sooner but the HMO won't let me go out of area and there is a huge waiting list for all 4 rheumotologists available.
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