What kind of medical specialist should my friend see?

(I hope this doesn’t constitute asking for medical advice, because all I want to know is what kind of doctor she should be talking to for the advice.)

A friend of mine, a healthy 22-year-old, slipped and fell (on a small hill) the other day, landed on her butt, and twisted an ankle. It hurt a little, but not enough to stop her from dancing around for four hours later that night. In other words, that night she felt fine.

Fast forward a couple of days and she suddenly wakes up in the middle of the night in great agony all over her body, concentrated most in her ankle, leg, and spine, but really all over. She was also extremely sensitive to touch, meaning anything from a hand or a blanket on her would cause excruciating pain. She spent much of the day writhing and constantly screaming :frowning: (This is definitely not normal behavior for her)

So fast forward 3 weeks to the present day. By now the pain has decreased in intensity, but it still comes and goes. At night, especially, she’d have recurring bouts of intense pain. This has left her in need of constant care; she can’t move around very well by herself and every 24-48 hours she’d experience so much pain that she becomes bedridden and barely able to move or talk. This would last up to a few hours, but then she’d feel relatively fine for another few hours. The cycle has constantly repeated itself over the past few weeks.

She’s seen two primary care physicians and one osteopath. A spinal x-ray showed nothing abnormal. The doctors weren’t exactly confident of their diagnosis, but they posited the possibilities of: sciatic nerve issue or a possible sacroiliac joint injury combined with something like a twisted disc.

With so little information, she doesn’t even know if this is something that’ll take a few weeks to heal on its own or whether she’ll need massive surgery or a caregiver for the rest of her life, and it’s putting her and everyone around her in a very difficult place.
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My question is: What kind of doctor does she need to see (or what kind of test(s) does she need to get) to get a better diagnosis and hopefully a treatment plan?** She has a MRI scheduled for a week from now (soonest they could fit her in), but in the meantime she’s still suffering greatly and there’s no assurance that anything will even show up on the MRI. The osteopath simply said “this isn’t my field and I don’t know what to do” and sent her back to the primary care physician, who has no clue what she can do either. Are there any other paths we could try?

Any tips would be appreciated. Thanks!

Is there one area, at present, that is the most painful and sensitive? Or is it truly ‘everywhere’? Any other symptoms?

No, it’s still generalized pain all throughout the body. It varies in intensity through the days, but not really in location… according to her, it’s just everywhere. (Though the ankle has healed and doesn’t hurt like it did anymore)

Other symptoms… tiredness and the occasional headache, sometimes tolerable, sometimes really bad all by itself.

IANAD. Your friend might want to visit an orthopedic doctor. Osteopathy sounds like woo to me.

Osteopathic (DO) doctors aren’t a separate subspecialty of medicine in and of themselves. They undergo a slightly different medical training than allopathic (MD) doctors, with the main focus being on what they call osteopathic manipulative medicine (OMM). I won’t go further into detail because I don’t know too much of the specifics, but saying she saw an osteopath is more or less equivalent to saying she saw an MD. It sounds like the DO in this case was probably a primary care physician, which is what the other two doctors were. An MRI sounds reasonable, and unfortunately can take a while to schedule and have done. She could also ask for a referral for a neurologist, but most likely the they will want the MRI as well.

I’d start with an orthopedic specialist and then maybe a neurologist.

It’s tough to know from the info given; that’s not a criticism of your description so much as it is an acknowledgment that her problem seems “undifferentiated”. By that I mean it’s not clear what system is affected and nor is it obvious what type of process is underlying her problem. In other words, it may be too early (in some sense of the word) to identify which specialist is most appropriate. When that happens, at least where I practise (Canada), referral to a general internist is often what’s done. That being said, in the US general internists tend to provide primary care and are not used as much to begin the investigation of such problems (or so I’ve been told).

Still, I’ll say she should consider a referral to a general internist (ideally one at an academic centre).

Well, with many insurance policies you start with your primary-care physician, who refers you to a specialist if he/she feels it’s appropriate. :slight_smile: That said, when one of my shoulders stopped working* my doc sent me to a physician specializing in sports-medicine. I gather “sports medicine” is a catch-all term for muscle-and/or-nerve ailments & injuries where the person can’t move normally, or does so with pain, even where the injury/ailment didn’t actually come from sports.

*Damnedest thing, it was. Went to bed one evening, didn’t do anything to injure myself that preceding day as best as I know, but when I awoke the next morning I couldn’t lift one of my arms to or above shoulder-level. No pain, just wouldn’t go up on its own. :confused: Though the sports-med doc never did figure out what caused it – he sent me for an MRI but I never finished it because I suddenly found out I’m claustrophobic :smack: – a few weeks of physical therapy prescribed by the sports-medicine doc put it all right.

Thank you for all the responses.

It turns out I confused orthopedics and osteopathy (didn’t realize the difference), but she did indeed see an osteopath.

I don’t think the difference between an DO and a MD is significant in this case, since both types of general practitioners seemed unable to pinpoint any specific cause or offer any specific treatment.

Next time I see her, I’ll mention orthopedists, neurologists, and sports medicine (who in my experience as well have been good at providing physical therapy, whatever the cause).

Here’s hoping for the best. I appreciate the responses.

That was supposed to say the “difference between a DO and MD is INsignificant”. Whoops.

I’d say go to a neurologist or an orthopaedic.

Advice in general is best suited to IMHO, so I’m going to move this over there.

Colibri
General Questions Moderator

You sure? :wink:

She shouldn’t have to tell her doctor what specialist she wants to be referred to. A doctor saying “LOLIDK!” and throwing up his hands, like the osteopath did, is so unprofessional. He should be experienced enough to say, “Well this isn’t my field, but here’s someone else you can try.”

I would wager a guess she’ll probably end up at a neuro eventually if they rule out soft tissue injuries (by MRI) and bone injuries (by xray). But her doctor is the best person to make this decision.

A physical medicine and rehabilitation MD might be a good choice.

This sounds like it could possibly be Reflex Sympathetic Dystrophy Syndrome:

http://www.aboutrsd.com/what_is_rsd.php

From the web site: “Reflex sympathetic dystrophy (RSD), also known as complex regional pain syndrome (CRPS), is a chronic progressive neurological condition that affects skin, muscles, joints, and bones. The syndrome usually develops in an injured limb, such as a broken leg. However, many cases of RSD involve only a minor, seemingly inconsequential injury, such as a sprain. And in some cases, no precipitating event can be identified.”
My mom suffers from RSD as a result of having broken an ankle. A neurologist is who she needs to see, IMO.

This

Depending on what is found in the MRI, and what is not found, she might end up in Physical Therapy. Oftentimes, the PT knows more about the mechanics of the problem, and can offer more positive results. Warning: PT hurts like Hell.

Another end solution would be a Pain Clinic.
~VOW

I suffered this type of injury many years ago - sadly I had a dumb as a box of stones doctor who thought I had severe period pain and just kept giving me painkillers - I didn’t have the strength to argue with him!

I was told, years later, that I “should” have been put in traction to straighten everything out and given physiotherapy to help stop it all twisting out of place again.

No idea what the current medical thinking on these injuries is, and IME she’s lucky a doctor recognised that she may have damaged her sacroilliac joint

Hope she’s feeling better now?