Pain in posterior part of leg above malleolus. MRI, nerve conduction studies came negative. Any advice?
The nature of onset of the pain is important. It is likely that this should be a lesion with either the ligaments or the tendons. Lack of signs of inflammation and intensification of pain on tension points towards a mechanical origin of the pain. Lesions such as mild tears within tendons could present as such.
A negative MRI however does not exclude in its entire these lesions.
Treatment from the beginning should be intensive, both medical and life style oriented.
1. avoid all positions as much as possible that intensify the pain
2. Local anti inflammatory drugs for a long time might help
3. Consider periodic injection of steroid for in bouts of three months, Triamcinolone 80mg IM/every three months with COX-2 inhibitors as oral anti inflammatory drugs from the start good starting points. oral steroids might cause gastritis and other signs of steroid intoxication (CUSHING s syndrome).
Failure of these measures should demand a reevalution by your treating orthopedic surgeon. Repeat x rays with different specific incidences could aid in the diagnostic process.
Thanks and best regards,
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