It's not Just Growing Pains: A Guide to Childhood Muscle, Bone, and Joint Pain, Rheumatic Diseases, and the Latest Treatments

By Thomas J. A. Lehman | Go to book overview

20
Reflex Sympathetic
Dystrophy,
Reflex Neurovascular
Dystrophy, and
Complex Regional
Pain Syndromes

Fourteen-year-old Cindy was the ultimate figure skater. Her parents
had met while skating in college. Briefly after college, her father had
skated professionally, but shortly after graduating from college her
mother stopped skating so they could start a family. Cindy’s father was
now a successful businessman, and Cindy’s mother stayed home to
promote Cindy’s development as a figure skater. Cindy had been skat-
ing for as long as she could remember. But for the past six months
Cindy had been unable to skate because of ankle pain. There was no
doubt about how Cindy’s ankle was injured. Hundreds of spectators
witnessed her fall at the regional skating championships. X rays did
not show a fracture but her orthopedist immediately placed her foot in
a cast to rest the ankle and make sure it healed properly.

After three weeks of complete rest, the orthopedist expected Cindy
to require only a few days of physical therapy before resuming full
normal activity. However, when the cast was removed, Cindy contin-
ued to complain of pain and was unable to bear weight on her foot.
Over the last few months every study has been performed to evaluate
the ankle and find out why Cindy cannot walk or skate on it. Her
blood work is normal, the MRI is normal, and X rays show only some
mild osteoporosis (loss of bone density). Her bone scan shows patchy
uptake that does not suggest a specific diagnosis. Since it has been six

-252-

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