Q: I am 22 years old. I have pain in the lower left leg from the past three years. It radiates from the ankle to the knee. It also causes pain in the calf mostly in the centre. I had a venous doppler test done and the doctor said there was some swelling but doesn't know from what. Anti inflammatories do not help. Recently I have been experiencing pain in my left lower arm, from the wrist to the elbow, in the middle. I think this could also be the tendon. There is also pain on the left side of my neck down to my left shoulder blade. I have poor circulation but I don't think that could be the cause of this. The pain is worse at night or while resting.

A:I have gone through the query and would like to give following advice. To start with I would like to dispel the myth that all pains in the body mean poor circulation. Though it is true that patients suffering from poor circulation do suffer from pain, but it is related to walking or the use of the limb. It is most unlikely to be because of poor circulation in this case as the person in question is only 22 years old and poor circulation is a disease of the elderly. There is however a possibility of younger people getting thrombosis of the veins and very rarely arteries, these may cause pains but not all over the body and certainly not in the neck as the blood supply of the neck is so profuse and from multiple sources that it is not possible to compromise the same. I found in the letter that he has had venous duplex scan and was reported to have swelling, it seemed to be a very vague report. I suggest that a scan be repeated and the venous thrombosis be confirmed or excluded. While the person is doing the venous duplex he could also scan the arteries, which I am confident would be normal. If the scan is negative then the next step would be to ask an opinion of a Neurologist and to have a thorough neurological examination. This along with the (Electromygraphy and Nerve conduction velocities) should give us a clue if the source of the problem lies in the nerves or the muscles or the junctional tissue. He may need further investigations like MRI of the local area or the spine to guide us further. I am sure a good neurologist should be able to help. The patient may not just assume that he has bad circulation and feel exasperated. There are means to conclusively prove or disprove the cause to be vascular or neurological.