Joe A Shaw PA-C - 9/23/2008

Question
Hi!
On 08/15/08, I asked you the information posted below. Of all the doctors, the neurologist they sent me to noticed some neuropathy in the leg so he has ordered an MRI....I have an auto immune disorder they think is effecting the autonomic nervous system..+sigh+.  It is not as bad as it was....still cant rollerblade or make quick cuts in running, and still hurts down the leg, but not as bad. What are the chances it will still show the problem if it has already started sort of healing??

Thanks for your time. vicki

Subject: injury to hamstring

Volunteer Expert: Joe A Shaw PA-C

Question:
QUESTION: I am a very active person. Most every day, I will get in 2 to
4 hours of physical activity. It will include walking,
bicycling,rollerblading, martial arts, and light weight training. One day a week, I
usually will participate in a group activity such as soccer or other
physically active game.I stretch a lot.

Problem.....I keep injuring left hamstring. It will audibly "snap", and
sometimes it will almost make me fall down. I am not sure if it is
because of the sharp pain or if the muscle just gives out. I can usually
catch myself with my right leg before actually hitting the ground, and I
will keep going because I'm stubborn, but I wont be able to put weight
on it without severe pain. I usually have to skip on my right for a
few steps until my speed is slowed down and I can walk it out. It has
been a problem since February of 2006, even with physical therapy, but the
last few months it has been A LOT worse. Sometimes when I'm in a
situation where I have to continue to be on it, it will swell all the way
into the knee and then the knee doesnt want to bend, but usually the pain
is mostly in the buttocks area. Working out is a stress reliever for
me and I really need to be able to continue to be physically active,
but the pain is getting extra annoying. Do you have any advice on what I
can do?


ANSWER: Vicki,
Hamstring injuries are one of the most frustrating injuries to get
over. I get tired just looking at your regimen, so I think you are
obviuosly over training or not allowing this to heal. You night have a chronic
tear,scar adhesions, hematoma or cyst w/i the muscle belly of the
hamstring or at the tendon insertion area (where the tendon turns to muscle
and attaches to bone). Surgery is usually not needed, but it is done
from time to time. You need an MRI to see whats going on. Sometimes they
will give cortisone injections in the specific area via ultrasound
guidance (not in the tendon).
I have attached the best article I know of and is a fairly easy read
even for a nonmedical person.
You could still do upper body workouts and what not to relieve stress,
but you are going to have to give that area a rest regardless of what
you find.

  http://www.physsportsmed.com/issues/2005/0505/fredericson.htm

---------- FOLLOW-UP ----------

QUESTION: the article you provided describes my problem completely.
Because I tend to mask pain and have trouble verbally communicating with
doctors, I have a hard time getting them to comprehend when something
hurts and i need help. You seemed to figure it out in one email. Any
chance the office you work for is in AZ, Southern CA or NV and is accepting
patients? Thank you again for the article. Also, do you know how much
if any that an auto immune / undifferentiated mixed connective tissue
disorder would factor in to the problem and healing or lack of healing
process? ..glad you dont answer queastions on the weekends. It is great
to know someone still spends time with family =).

Answer:
Vicki,
I'm glad it helped. No I am in TN. You did a good job of describing
what is going on and it was all written down so I had to read through the
whole thing, unfortunatley in real life in a clinic you would have
probably gotten 1 or 2 sentences out and would have been interupted with a
question and that would have thrown your train of thought off and put
you in the position of just answering yes or no. Now sometimes pt's do
ramble and we have to keep them on track but often we try to get to the
question w/o really listening to the whole story.
I do recommend that you write down your questions and/or a good summary
of what makes it worse better etc..what you have tried and not tried
etc.. on index cards and take them with you in the exam room..it will at
least give the provider pause and you can have your questions answered
so you don't forget or get distracted. I would also print off that
article, it is from a reputable source..you don't have to wave it in front
of him/her but I would let them know that you have read it and it
seems to fit your situation. Try and find a sports med ortho. You can see
if orthofind on my site has one in your area.
I do think that these nonspecific mixed conn. tissue findings cause
delayed in healing, I don't know of any studies, but just from exp. it
seems to be the case, but I still think you have something going on w your
hamstring.
good luck, let me know what you find out


Answer
Vicki,
Yes the MRI can show acute injuries but also chronic injuries and or scar tissue. The question usually is okay she has an old tear etc..is it worth going in and trying to fix it or not..this depend on where and what kind of tear how the person is progressing or not, how aggressive the pt is in wanting it done etc..
What kind of auto-immune disease?..this can delay healing in my experience.