Sunday, November 4, 2012


One day in EMG clinic, we had a patient with wrist pain and intermittent wrist swelling. His workup for rheumatological disease was negative and his EMG only showed mild carpal tunnel.

Attending: "So do you think he has RS3PE?"

Me: [thinking: "Am I supposed to know what that is??"] "Uhhh...."

Attending: "That's Remitting Seronegative Symmetrical Synovitis with Pitting Edema."

Me: "Um."

Attending: [points to bulletin board, where article is pinned up] "We saw a really interesting case of it last week. I'll bet that's what he has. Was his sed rate elevated?"

Me: "No."

Attending: "Maybe that's because he got prednisone."

Me: "It was normal before the prednisone."

Attending: "Well, it could still be RS3PE! We should put that diagnosis in our report!"

Me: [thinking] "Just because you have an article about something on the wall, that doesn't mean every patient has it."

I guess the diagnosis is possible. I love the fact that instead of calling it RSSSPE, they call it RS3PE.


  1. Reminds me of the quote, "when all you have is a hammer, everything looks like a nail."

  2. That hammer quote above is true!

  3. I don't even go that far. I just write "Mild carpal tunnel syndrome. Clinical correlation is advised."

    Let the ordering physician deal with it.

  4. Oh dear. Sounds like yet another scientific doctor. By virtue of walking in his exam room, you have one of the following 3 diseases.

    What? It doesn't quite fit? Well, it's certainly not RA. It doesn't seem to be explained by carpal tunnel. It must be {insert random obscure disease} via diagnosis by exclusion.


  5. It could probably be turned into a song! :D

    R 3 S P E, C T
    Find out which one it could be...