Hello,
I have discussed your case with our Orthopedician and unfortunately we will not be able to provide much insights into your problem. This is because of the limitation of the "online consultation model".
However we may be able to contribute some limited, but valuable information from our side. So if you wish to continue the consult, please let me know. ( In that I case I will replying from my email ID). Or else you can go for a refund.
Thank you
Patient replied :
I understand the challenges in doing online consultation, but I am happy to receive any useful information so please continue the consultation.
Thanks
Hello,
I would like some clarity and additional information on the symptoms :
1. Are the clicks, snapping or grinding noise audible to others. As in
like have the Doctor / friends or family has commented that they can
hear the click ? ( I read that your Doctor has confirmed your
symptoms. This mean the click ?)
2. Do you mean to say there is no pain at all ?
3. How prominent is the grinding noise ? Is it audible to others ?
4. If I say your major symptoms are the instability and the grinding
noises, am I correct ?
5. There are no joint swellings anywhere, I assume.
6. Is the mobility of the joint restricted ? . For example are you able
to raise the shoulder fully or bend the knee.
7. Do you have anything unusual in your ear, nose, eyes or throat ?
(anything unusual ? for example pain and warmth of ear )
8. Is there any darkening of urine (while standing, that is on the
toilet)
You can reply as a followup.
Thank you
Patient replied :
Hi,
You will find my answers under each question.
1. Are the clicks, snapping or grinding noise audible to others. As in
like have the Doctor / friends or family has commented that they can
hear the click ? ( I read that your Doctor has confirmed your
symptoms. This mean the click ?)
“The clicking sounds are audible to others and typically come from my knees, ankles, elbows, wrists and shoulders. If I repeat a motion (many times in a short timespan) with one of those joints I will, usually, be able to stop the clicking. Still, it will be just a few seconds without movement until the joint will start clicking again. My doctor has confirmed my symptoms. The clicking is audible to everyone, so this was confirmed right away. In addition he “tested” my joints by touching the joints while I moved, pulling my fingers and legs, “twisting” my knee etc. He did this all over. He found two things. 1. He could feel the laxity in the joints and the grinding sensation. 2. He could not find any abnormalities, swelling or signs of inflammation”
2. Do you mean to say there is no pain at all ?
“Yes. Up until now I have not felt any actual pain, just a highly uncomfortable feeling”
3. How prominent is the grinding noise ? Is it audible to others ?
“The grinding noise is usually not audible to others unless I provoke it by rolling my arms (shoulderjoints) around in a circle. This will create so much grinding noise that it is audible to others. The clicking sound (question 1) is more high pitched and the sound is something like what you get if you break off dry wooden sticks. The grinding sound is most prominent in my upper body, especially the sternum / ribcage, shoulders and neck. Typically, when bending slightly forward doing some housekeeping, I will hear and feel this grinding in my shoulders and ribs. The sound itself is low pitched, like my example with the wooden sticks but this time with a layer of cotton insulating the sticks. (Might be a bad example but I guess you see what I’m trying to say ?)”
4. If I say your major symptoms are the instability and the grinding
noises, am I correct ?
“Yes, grinding and instability are my major symptoms. The high pitched clicking sounds from knee joints etc. is somewhat common I guess. I mean, most people experience this from time to time. Some more than others. For me though, this is all new and in addition it is widespread. The grinding is more uncomfortable, and the sensation I get moving my upper body (torso) is as if none of my ribs is really attached to the sternum and spine. As if they are floating freely. One exercise that really provokes this is doing regular pushups. Did this as part of my exercise routine after back surgery, but now it is so uncomfortable that I have stopped. “
5. There are no joint swellings anywhere, I assume.
“No, no swellings. This is partly the reason why I was rejected by the specialists in rheumatology. That, and the fact that none of my blood samples indicated rheumatic diseases.”
6. Is the mobility of the joint restricted ? . For example are you able
to raise the shoulder fully or bend the knee.
“No, the mobility is not restricted. “
7. Do you have anything unusual in your ear, nose, eyes or throat ?
(anything unusual ? for example pain and warmth of ear )
“No, just tinnitus in my left ear, but this has been going on for more than a year so I guess it is not related to this problem? I also experience more sound when I swallow and a feeling that there is more “motion” in my throat. A bit hard to explain really.”
8. Is there any darkening of urine (while standing, that is on the
toilet)
“No, I haven’t noticed any change. My urine is a bit darker in the morning, as always, and gets brighter during the day.”
One thing I could mention is that I do not need to put much stress on my joints to make them click or grind. For instance, sitting down I just need to flex my chest muscles (with my arms hanging straight down) do provoke a small snap or grind in one or more of my ribs or in the joint between the clavicle and the sternum (if that is where it is attached?). If I put a couple of fingers on this joint while flexing the chest muscle I will feel the bones move slightly apart, creating the grinding sound, and slide back into place as I relax my chest muscle. I feels like the joint moves a little too much and that the knuckles grind on each other bone against bone creating an uneven motion. As if there is no coating or fluid to cushion the joint. But again, no pain, just a faint soreness in the muscle if I repeat it too much.
regards,
Oystein
With Inputs from Dr.Bimalesh Pandey, (SR. Rheumatologist), Dr. Tiwari (Orthropedic Surgeon)
1. We recommend evaluation in line of a “polyarthritis”. That is arthritis of multiple joints. This is based on the dictum that ‘uncommon presentations of common disease is more common that common presentation of uncommon disease’. You will require a basic work up and Xrays to rule out Rheumatologic disease like Rheumatoid Arthritis. If these are already done and found negative then there is no need to repeat the tests.
2. The clicks and grinding can be present normally. But since it is widespread there is possible involvement of cartilage. When cartilage is lost or damaged there can be friction between bone and ligaments causing this kind of sounds. Trauma or mechanical damage will not cause this widespread disease. Since multiple joints are involved, autoimmune cartilage damage could be considered. In this condition there are antibodies against the type of cartilage causing widespread cartilage damage.
This is the mechanism of disease in Relapsing polychondritis. (You do not have the typical symptom pattern of RP though). But a similar mechanism can exist.
3. Besides the baseline investigation for arthritis, you might need a synovial fluid analysis, cartilage biopsy and MRI of multiple joints
4. The absence of pain is a good sign. The symptoms could be part of a hypermobility syndrome, which usually is harmless.
5. If everything is normal (after the investigations) a wait and watch approach can be considered.
Hope this helps
Please feel free to ask followup questions.