Ladies and gentlemen and everyone else,
I am seriously alarmed by the diagnosis that my doctor, now a second-year-resident, made the other day. I thought that she said I had popliteal tendinitis. The diagnosis on the patient summary was pes anserinus tendinitis. These are very different tendons. Now, if you don’t want a bit of an anatomy lesson, I’d say go now. I’ll only use tables and not cadaver images,1 so if you’re interested, but worried you’ll see some limb of a dead dude, there is no need to worry. I promise that I won’t be really gross about it, but if anatomy just isn’t your thing and you want to skip this entry, that’s totally fine.
Since all good anatomy lessons start with the basics, maybe we should start at what a tendon is. A tendon is a type of connective tissue that connects the muscles to the bones or to other muscles. Ligaments connect bones with other bones. Bones are the things that you drink milk for, unless you’re lactose intolerant or have a milk allergy.
I present the popliteal tendon, which sits right at the “knee” above the fibula in the back. The fibula is the bone on the outside of the calf. It’s the bitty bitty, in width, bone that keeps the ankle stable and holds the muscles in place. Injuring this tendon is pretty rare unless you injure other things in the knee. Symptoms of popliteus tendinitis are inflammation, pain, swelling, or tenderness outside of the knee. The more the patient does before it is treated, the more likely the patient is to build up scar tissue and that causes pain every time you move the joint.
This is the pes anserinus. The pes anserinus is a group conjoined tendons of three muscles that insert onto the front and inside part of the tibia. The symptom of this type of tendinitis is pain that develops on the inside or center of the shinbone about 3 inches below the knee.
Now, where does the pain happen to reside? The worst pain is on the outside of my knee. It is toward the back of my knee. It hurts when I bend my knee. It hurts the more I used it. The minor pain on the inside of my leg and on the front of my leg is actually above my knee. I’m not diagnosing myself. There are tissues of different sorts making up the area in and around the knee. I’m not going to say it’s one or the other, but I am going to say that if it’s the pes anserinus, then it’s probably a case worthy of some peer-reviewed studies. It would have to be the weirdest case ever.
The diagnosis is why I am alarmed.
I told the doctor exactly where it was hurting. She even examined the outside, back area. But she not only suggested a part that is in a totally different area, she officially diagnosed it. And the attending2 signed off on it without actually examining the joint. I shouldn’t have to know the actual make-up of the knee joint because that’s their job. Doctors spend all of those years in school studying anatomy. When they get to the Residency program of one of the best medical schools in the country, they should know the structures of the knee and what sides those structures are on. She only has this year and next left in her residency, and this is something she should have known before she even became a resident. Even as a family practice doctor, she should know this stuff. If she was planning to be a psychiatrist, I wouldn’t be so scared, but family practice doctors deal with joint injuries. Mistakes made in treatment could cause grievous injury to otherwise healthy people.
This is scary stuff.