The man in his mid-seventies had been suffering from severe pain in his right knee for more than a year. He told me he hardly had any discomfort when sitting. But when he runs, every step hurts. He had an arthroscopic procedure six months ago. A camera is used to look inside the knee joint. The surgeon discovered nothing unusual. A practicing orthopedist then ordered an MRI scan of the lumbar spine because deep back pain can also radiate to the knee. There were signs of wear and tear, which was normal for that age. In fact, the findings on such images rarely correlate with the symptoms: There are scientific studies that show that some people with severe signs of wear and tear have no pain at all. Others suffer a lot without anything being visible in the pictures.

Because there was no conclusive explanation for the symptoms, the patient received physiotherapy and pain-relieving injections for weeks. The pain continued. He then went to see another orthopedist. The doctor apparently had no other choice than to order another magnetic resonance imaging. The radiologist discovered a fracture in the images: a fine hairline crack ran in the upper third of the right femur. The fracture finally explained the symptoms. With every step, the unhealed ends of the fracture moved and irritated the surrounding tissue.

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