CERVICAL STENOSIS CASE FILE

An elderly man, let's call him Mr S, gives cause for thought in our Cervical Stenosis Case File. He consulted me two years ago with acute pain in the upper right groin and thigh of some months duration, with no known cause. It turned out to be a routine case of Meralgia Paresthetica, a condition seen quite frequently in our clinic. Meralgia Paresthetica, what's that?

In passing he mentioned that he had sprained his ankle about a year previously and that it was still causing some pain. Could that be the cause? he asked. I agreed that it could, by altering his gait. At this stage, he had already consulted his doctor and a physiotherapist concerning both the ankle and the pain in his opposite thigh.

The pain in the hip responded relatively quickly, and after a few weeks he went off on an extended hike in Spain. The hike was very successful and he returned some two months later for maintenance care of his hip. In passing, he asked about his ankle.

A confession. In the ten minutes set aside for routine maintenance of the hip and groin, I completely missed the fact that he had quite profound weakness in the ankle, the cause of the sprain, not a result of the sprain.

He continued to consult me every two months, not unhappy, despite the lack of progress in the ankle. He also had a stiff neck that required mobilisation. More about Sprained Ankle.

One year ago he returned urgently from an extended holiday in the Greek islands to consult me. I was immediately very concerned. He had extreme gait disturbance and some signs of what I thought was a possible lesion in the Cerebellum, a part of the brain. He also complained of tingling in the hand. It was only then that the penny dropped: the weakness in his foot was not local, but rather neurological in nature. I referred him immediately without treatment to his doctor for an urgent consult with a neurologist.

The neurologist decided that he had carpal tunnel syndrome and referred him to an orthopaedic surgeon. Carpal Tunnel Syndrome, what's that?

The orthopaedist concurred and procedeeded to operate on his wrist.

Mr S continued to walk like a drunken old man, and being a man of some influence, bypassed all the fools treating him and went to a specialist clinic. The diagnosis after an MRI of his neck: Cervical spinal stenosis.

I'm glad to say that both Mr S's medical doctor and his chiropractor have both escaped his ire, though we both too completely missed the boat. I'm not proud of myself, but this Cervical Stenosis Case File been a great learning experience. It's not called a "practice" for nothing.