MUA ROM and Manipulation Question

[maryo52]

Re: MUA or Surgery??

Hi

Know the territory well.

I had an arthroscopic procedure to remove my scar tissue. I had massive amounts. From the studies I've read, this has the best results, better than an open procedure. The reasons is that the less invasive, the less likely to stir things up again (which makes the scar tissue grow). Has this possibility been mentioned by your doctor? It's really no worse than MUA, maybe even a little easier because it's not as traumatic.

For those of you who didn't have scar tissue, imagine this: material that grows in and around your knee joint very much resembling cartilage or ligament tissue. I had a quarter inch diameter band tethering one part of my knee to the other. That's a virtual ligament! It was broken during my MUA but grew back rapidly despite daily stretching. So no modification of other therapies is going to make a whit of difference when scar tissue is involved. In fact, the more PT we do when scar tissue is gluing everything together, the worse our pain gets.

The other piece to having arthrofibrosis is the profound sense of discouragement and disappointment from diligently following prescribed course of action with no results. I watched my knee bend to 120 yesterday and remembered when it was 80. When it was stuck at 80, I would avoid even looking. It broke my heart. Unless you've been stuck at a low ROM, it's hard to realize how difficult this is in so many ways (for instance, being 60 and feeling like so many things have come to a screeching halt!!)

Vicki, don't give up. The fact that your surgeon didn't mention the arthroscopic route means that he probably doesn't do it. It might be time to entertain a second opinion with someone who deals with post-tkr problems, in other words, someone who does revisions. Each surgeon has a comfort zone. There are things they feel comfortable doing and not doing. This doesn't make them bad. We just have to recognize it and not let that stop our personal progress. For instance, there are surgeons who will do a MUA this far out. So, shop around my dear! Here's a link to an article that is way more comprehensive than you need but may be helpful. www.upoj.org/site/files/v21/v21_18.pdf

 

[Vicki Lynn]

Re: MUA or Surgery??

The swelling is better - it will still kick up if I over do. Like yesterday I was on my feet too much and walked twice - this morning I was swollen - but not too bad. I took it easy today. I will work on the stretches. Thanks - the one to straighten looks like it would be really good for me. I will try the rocker trick that got posted after yours. I think when I get discouraged - I don't do all the stuff at home as I should.

Thanks so much!

 

[Josephine]

Re: MUA or Surgery??

I had a MUA on Feb. 24th - which did not gain me any ROM. I am at maybe 60 and I also cannot get the leg straight... maybe a 9

The Dr that did my original surgery wants me to do another manipulation. This Dr. says he got little resistance the first time he did the MUA and bent my leg all the way.

This would tell me and should tell you, that there are no adhesions in your knee! Unless the surgeon is lying, of course! If you have adhesions, there is no way he could do that. None whatsoever.

I saw a corrective surgeon who thinks I need to go into the hospital - open the leg up and get rid of scar surgery and do a procedure that cuts the muscle in the back of the leg to get it straight.

To do what? The other surgeon has already said he could bend your knee "all the way".

And - I'm just now starting to feel better. It has taken a really long time for swelling to go down and pain to decrease.

So tell me this
1. how swollen has your leg been all this time?
2. how much pain have you be having - overall, grade it from 1-10, 1 being no pain and 10 being the worst you can imagine
3. what about pain meds? What are you taking, how much and how often?
4. what kind of activity are you doing on a daily basis? Including house work, PT and a job and anything else you can think of1
5. how much time do you commit to elevating and icing?

Answer me those point by point and I will return with some more advice! :wink1:

 

[Vicki Lynn]

Thanks - I'll answer the questions by point:

1 - Swelling is still here - but much more minimal. You cannot see the outline of the knee due to swelling - and sometimes it swells a bit more with over activity. The back of the knee feels swollen and at times is still sore - like if it is on a hard chair rim.

2- I am not off of pain meds -(hydrocodone) and use ibuprophren or another Nsaid. This is as of the last week - 10 days. Its more stiffness than pain and sometimes pain in hip because my range is bad and I put pressure on the hip.

3 - Daily activities - I'm working 30 hours a week. My job is public relations for a Hospice. This means driving, getting in and out of car 4-5 times a day and some walking to buildings. I shower, make beds, cook, vacuum, etc. Nothing real heavy but I can do most things that you can do standing.

4- I only elevate and ice if it swells up. I am sleeping at night finally, and other than I can't move the leg - and it fatigues fast - I really feel much better.

5 - My new knee kept my knee cap. It doesn't move at all. The 2nd surgeon discussed replacing the knee and cutting the muscle in the back of the leg because I cannot straighten the leg. Its at about a 9 - 10. I have worked and worked at getting it straight with therapy and at home. It improves slightly at the session and is back to 9-10 before I even leave. It got worse with the manipulation - I was at 6 before then.

I'm considering getting yet another opinion. I sure don't want a surgery if it's not needed - and I don't want to do the MUA if it is like last time. It really didn't gain me much of anything and made the straight worse. I may have gained 10 degrees.

Thanks - I'll be waiting.

Vicki - this site is a great encouragement.

 

[Josephine]

Then your knee is swollen 90% of the time! What tells me this is that a) you say it feels stiff and sore, b) you have stiffness and c) you're doing quite a bit even though, at 5 months, you would have a right to expect to.

Quite a lot of people fall into the misapprehension that 'stiffness' is something other than pain. It isn't. It's just another manifestation of pain and should be treated as such. In this article The importance of managing pain after a TKR and the pain chart you will find the following
Post-op pain ... manifests itself as
soreness
burning
stabbing
throbbing
aching
swelling
stiffness

You didn't say how much hydrocodone you are taking or how often but I'll warrant it's probably once or twice a day, yes? I think you might find this a bit more effective Tylenol/ibuprofen cocktail - you don't need narcotics to get good pain management but you do need good pain management!

As for icing, you need to be more proactive about it and not reactive. Make a plan of icing regularly for about 30-40 mins at a time and elevate while you do. You might find it useful to read this article Swollen and stiff knee: what causes it? and understand how swelling can affect ROM most efficiently!

I do hope you don't let him start cutting muscles to get this extension problem resolved. It really doesn't and it's a really painful procedure. Please go back to my first post #5 and read all the articles again. The articles I've given you here were in that list but somehow you don't seem to have taken them on board! Please do read them.

 

[Campervan]

Re: MUA or Surgery??

........ I will work on the stretches. ........ I think when I get discouraged - I don't do all the stuff at home as I should.

Hi Vicki Lynn,

I know just how you're feeling. My surgery was 2 weeks before yours. My ROM is higher than your's but has been stuck at just over 100 for months. Extension is almost zero. Its stiff if I leave it in one position for too long, eg sleep with it bent and its painful to straighten. About a month ago I had a meltdown and told myself the exercises were doing nothing so why bother! So I stopped. Three days later I was significantly worse off with stiffness and pain. So, back on the paracetemol and diclofenace and I started doing the exercises again.

So even if you are feeling down, you need to force yourself to do the exercises. Mine take me 20 minutes and I do them every morning after I get out of bed. Basically, clean my teeth and then exercises, then breakfast, coffee and catch up on Bonesmart, ride exercycle for 20 minutes, shower and then work. I'm lucky that I can work flexi hours and from home.

Here's my morning exercise routine - 10 of each
1. sit on chair - heel slides with foot on a magazine, push with other foot
1(a) forgot this one - sit on chair, foot on other chair at same height, put a scarf with 3lb weight tied to each end over quads and sit there for a few minutes (and I have a cup of tea while doing this one).
2. stand up, sit down. Slowly, with arms crossed over chest.
3. lunges with foot on stool - hold each for count of 10
4. squats down wall
5. step ups, onto 20cm high step. Lean forward and make sure pulling up with TKR leg not pushing up with other (may need to hold onto something for support)
6. stand on same step, non-TKR leg off to side of step and lower non TKR leg so squat with TKR. Again my need something for support.
7. On bed, heel slides - same as ones done in hospital
8. Straight leg raises
9. Rugby ball under knee and raise leg from knee
10 Lie on tummy, and lift leg backwards, ankle towards backside. Hold each for count of 10.

As I say, takes around 20 minutes and if I don't do them I'm definitely stiffer.

Hope this all helps you.

 

[Vicki Lynn]

Thanks so much,

I have printed your morning routine and will start try these today. I really appreciate the specific list and am going to give myself a month or so to see if I feel improvement. It helps so much to talk to others that have had a slow go of it - I feel like the lone ranger in the PT room or the Dr office.

I had someone recently tell me that if I waited - my muscle would atrophe and I would lose 12% of range. It really still sounds like I need to be patient and just keep on keepin on. I yo yo on what to do and I frustrate myself.

Thanks for your kindness and input.

Vicki

 

[Vicki Lynn]

Josephine,

I am re-reading your articles and will start the Tylenol cocktail and see if it helps. I sure don't want to do another surgery!! I have to run off to work - but will be in touch tonight.

Thankyou

Vicki

 

[Campervan]

Hi Vicki, glad to be of help. I know how frustrating it is to read a great deal of posts that say ROM at 125 after a few weeks. I just cant get there - or can't yet. But I can do so much daily living tasks that I couldn't do 2 months ago. I was finding walking up stairs very jerky until my physio said I was pushing with my lower leg and should be pulling up with my upper leg. She told me to lean my weight forward, plant my foot on upper step and make sure I pull up. It really does work.

 

[Josephine]

Vicky, would you be a dear and put your surgery date in your signature like the rest of us do?
You can find the instructions here How to create a signature.

 

[Vicki Lynn]

Josephine,

I have changed my signature to include the date of surgery. When I originally started looking at BoneSmart I really mostly read things and didn't write much. I'm getting better at finding threads now but still am learning.

What is your opinion on a 2nd manipulation? I think I want to wait until after Summer in any case.

 

[Josephine]

Thanks for the signature, very helpful!

And I did answer you about the further treatment ....

Then your knee is swollen 90% of the time! What tells me this is that a) you say it feels stiff and sore, b) you have stiffness and c) you're doing quite a bit even though, at 5 months, you would have a right to expect to.

Quite a lot of people fall into the misapprehension that 'stiffness' is something other than pain. It isn't. It's just another manifestation of pain and should be treated as such. In this article The importance of managing pain after a TKR and the pain chart you will find the following
Post-op pain ... manifests itself as
soreness
burning
stabbing
throbbing
aching
swelling
stiffness

You didn't say how much hydrocodone you are taking or how often but I'll warrant it's probably once or twice a day, yes? I think you might find this a bit more effective Tylenol/ibuprofen cocktail - you don't need narcotics to get good pain management but you do need good pain management!

As for icing, you need to be more proactive about it and not reactive. Make a plan of icing regularly for about 30-40 mins at a time and elevate while you do. You might find it useful to read this article Swollen and stiff knee: what causes it? and understand how swelling can affect ROM most efficiently!

I do hope you don't let him start cutting muscles to get this extension problem resolved. It really doesn't and it's a really painful procedure. Please go back to my first post #5 and read all the articles again. The articles I've given you here were in that list but somehow you don't seem to have taken them on board! Please do read them.