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GimpyGal

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Hi, BoneSmarties! I just dug out my very dusty password and located my old recovery thread. It's been just over a year since I posted and it's no longer open to replies, but I need to continue my saga. I need to pick your brains with a new knee problem that is stumping my doctors.

I'm not really in a pre-op situation since we can't confirm the problem, and not really in a post-op place either, since it's my other knee. Where do you prefer I post? Should I begin a new conversation or should my old thread be re-born?

I can't believe a YEAR has gone by!
 

Celle

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Hi @GimpyGal
I'm pleased to see you back, but not because you have a problem.

If it's your other knee, I'd be inclined to start a new thread. Post about it in this thread for now and we'll move it to the Pre-op Knee forum if the moderators think it's more appropriate here.
 
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GimpyGal

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Thanks. Pre-op is likely the right place. I'm hoping for no OP at all!

To pick up where I left off in Sept 2014, my LTKR is now fabulous! I battled an over-use injury during a move, but it settled down and the new knee is never even thought of anymore. Isn't that where we all want to be?

Janurary: Now, onto the right knee. We moved (temporarily) to our vacation home in January and my right (natural) knee bothered me right off - the move was hard on it. I figured with the move "out" behind us and living on a single floor things would settle down, but they didn't.

February: MRI discovered a meniscal tear, and nothing much else. Tired a steroid shot with no relief.

March: OS took care of the meniscus. He said we hit a home run! It was a significant tear but easily corrected. While in there he looked good and hard at everything. He said the right knee looked fabulous - very little arthritis, cartilage in great shape. This was not the case when he took care of the torn meniscus prior to my LTKR. He said he couldn't imagine me needing a TKR for many, many more years.

April-August: Moved into our brand new one floor home. It's heaven not having any stairs. Move was not too hard on the knee, but still no relief from the pain. It's the same as before meniscus removal. Sent to PT. No improvement in 5 weeks. At next appointment he suspected bursitis - got shot in bursa. No change. Started improving a month later and finally had a normal gait, (golfed a bit) and regularly attended non impact water aerobics classes 3X/week. Still pain, but less. Back to walking the pup!.s

Now (September) dramatically worse with no change in activities prior to change. I can no longer do the PT exercises because most involve me standing on the affected leg and that's not possible with the pain level. Knee collapses under me I'm in such pain. Barely getting around with a cane. I can do none of my normal activities like housework and shopping. I literally cry out when electric pains shoot down the inside of the knee down the shin. They don't occur with each step, but several times as I walk across the room. I've tried rest, elevation, compression, anti-inflammatories, ice, heat, massage.

Went to a Sports Medicine doctor just for a different set of eyes to look at me. He also felt it could be bursitis, and gave me a cortisone shot along with the anesthetic that's injected along with it. It never relieved the pain or changed the situation. His plan last Friday was to send me to a different PT who was really good at biometrics? biomechanics? I had an appt today.

However, I was in such pain I called my surgeon instead and he worked me in. It's still all a mystery. Did new xrays and all is fine. He doesn't think it's my back or my hip. My ligaments are doing their job and he mentioned they don't usually cause such pain anyway. I practically begged for a new knee (and that was the worst time in my whole long life) and he said the problem with that is he's not convinced the pain is from within the joint. So, obviously, I could go through all that and still be left with a leg I can't walk on!

The immediate plan here is today I got an injection (steroid plus anesthetic) into the joint. It's only the second time since this began - the other two were in the bursa. Theoretically, if the knee feels better with either drug, the problem IS in the joint and I'm probably looking at a TKR, although he sees no valid reason for one. It's been about 5 hours and if there is any improvement yet from the anesthetic, I don't notice it.

If I don't improve, it's NOT the joint and he can't figure out what it is!

I asked about the 'other injections' out there and he reminded me they are specific to arthritis and he's seen my knee during surgery and it's all good! He says I have 35,000 miles left on a 40,000 mile knee.

So, what is everyone missing here? What's the next step? I think a second MRI might be in order if there is no improvement in the two weeks before my next appt. Perhaps PT with the new guy? I'm on a strong anti-inflammatory, too. I know he'll also likely send me to a colleague for a second opinion or to catch something he's missed. Beyond that, have we left any other stones unturned? I want my life back!
 

Celle

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OK. I'm going to ask @Josephine for her opinion.
I'm also going to ask for your thread to be moved to the Pre-Op Knee forum.
 

skigirl

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I did move your thread into the Pre-Op forum---I think you will get more responses here. I am glad that Celle tagged Jo because she is probably the best one to give you advice on this knee.
 

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Well hello! So sorry to hear you are having problems. In order to get a handle on things, I'm going to ask you a lot of questions - sorry about that but it has to be.

Can you tell me the exact site of your pain using this chart?
Please note the instructions in the smaller image

aflagsforworship.co.uk_jo_pic_images_referesrs.jpg


aflagsforworship.co.uk_jo_pic_images_aagridhyh.jpg


And now these.But just to complicate things, I want you to answer them twice: first time for what you did in the first three months and second time for what you're doing now.

It would be very helpful if you would answer each question individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what were/are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't compare this with the bone-on-bone pain you had before surgery!
aflagsforworship.co.uk_jo_pic_images_nonofisss.gif
)
Also don't forget to include other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness

2. what pain medications were you been prescribed, how much are you taking (in mg please) and how often?
And what are you taking now?

3. how often were/are you icing your knee and for how long?

4. were/are you elevating your leg, how often and for how long?

5. What was your ROM - that's flexion (bend) and extension (straightness) and what is it now

6. what was/is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

7. what kind of PT exercises and exercises at home are you doing? How much and how often?
And what are you doing now

Can you detail it like this

Exercises done at home: 3 sessions a day
Heel slides x10 (reps)
Strait leg raises x10
Steps x10

At PT
Squats x5 (reps) x2 (sets)
Wall slides x5 x2
Clamshells X5 x2
 
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GimpyGal

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@Josephine - will do this tonight when I'm home on the computer. Thanks for your attention.
 
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GimpyGal

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Here goes. I realize your questions are likely copied and pasted. Just want to reiterate I am not currently pre op or post op. Still in the diagnosis process.

As far as the chart the origination of pain is DRF2 but travels all the way down the leg (on D as far as FRF2).

1. Pain at rest is virtually 0 - maybe just under 1. Pain on walking can be anything from a 4 to an 8, depending on chance. Some steps are okay and then - zing! - lightening goes down the leg. Sometimes I can get away with walking across a room slowly with maybe a 3. Sometimes it hurts so much with each step I can hardly talk myself into continuing. The time of day or how much I'm on my feet or whether I've stayed off them doesn't seem to make a difference. For example, I'm no better first thing out of bed in the morning than I am cooking dinner at night. The pain when walking is stabbing. The at rest pain that is low is achy. No stiffness or soreness really until today after yesterday's steroid shot.

2. Since this began in January I've been taking 800 mg Ibuprofin 3X daily. I have serious all over swelling with it and switched to 7.5 mg Meloxicam last Friday - twice a day. I've tried Tramadol but it seems useless with pain that is not ongoing at rest so that didn't work. Also, not that I would take it for this, but I can no longer take narcotics due to a serious reaction to them. (Vomiting and dizziness.)

3. I've basically been icing since January, every time I sit down. 20 minutes on. 20 minutes off. I sit nearly all day, so at least 8-10 times a day or more. No icing during sleep. This has not changed between before the meniscus surgery and now.

4. I ONLY sit with my legs elevated in a recliner. However, they are not always above my heart except during sleep. This is what I did before meniscus surgery and now.

5. My ROM is excellent. Not measured at PT because not an issue. Fully straight, fully extended, before and after meniscus surgery.

6. A usual day then and now is mostly sitting just due to the pain. I am able to cook without too much pain - standing is fine and can manage laundry if it's brought to me. Can drive. Shopping (because it involves walking) is painful and avoided unless a must. Can't walk dog or golf. I WAS walking the dog and golfing a bit before things went south a few weeks ago. I WAS doing water aerobics 3X weekly until things went south a few weeks ago.

7. PT for three weeks after difficulty continued after meniscus surgery. It involved daily exercises - ALL were 10 reps each, twice a day. I can no longer tolerate the ones done on one leg and have stopped them.

a. Stand on affected leg with feet forward and together and lift leg good leg about a foot to the side.
b. Same as above but lift leg straight in front.
c. Same as above but lift leg across body in front.
d. Same as before but lift leg straight back.

e. lie on side with good leg bent behind. Keep body straight. Lift upper leg keeping it straight.
f. lie on side with both legs bent and body straight. Keeping legs bent lift upper leg up and release.

g. stand on bad leg and throw a heavy ball into a trampoline and catch it when it bounces back. Do this facing the tramp, then from each side. BTW, this was impossible - I've lost all my core strength.

h. Using a band tied to a pole or slammed in a door, stretch it until taut and then slowly pull leg back.

i. hang heels off a step (to stretch the achillies)

None of this helped with the pain and now that the pain is worse, most have been abandoned. I have on my own been doing 50 straight leg lifts once a day on both legs because I think it's important to keep my quads strong.

Update from yesterday steroid shot in joint. No change even from the anesthetic injected along with it.
Also no change from the shot in the bursa - never got pain relief from either the anesthetic or steroid 10 days ago. So, wondering if this means the problem is neither the joint OR the bursa.

Another thought. Sometimes when the pain is awful I can contort myself into weird positions to make it across the room. Like walking extremely bent over or lock legged or flat footed - even backwards. Hey, whatever can get me across the room! What works one time doesn't work the next. Using a cane helps and I really rely on it to take the weight off my leg. I'm overweight but not morbidly obese - 5'6" 195 lbs. I'm wondering if by allowing myself to not walk with a normal gait when I can't stand it, I'm messing things up more. That biomechanics thing?

Also, I've tried compression sleeves, elastic wraps and a brace. No relief from anything. And I guess it doesn't hurt to mention I personally believe I have a low tolerance for pain. What my husband might shrug off can be a pretty high level of pain for me.


Thanks for letting me pick your brain, @Josephine. What stone have I left unturned?
 
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Josephine

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1. Pain at rest is virtually 0 - maybe just under 1. Pain on walking can be anything from a 4 to an 8, depending on chance. Some steps are okay and then - zing! - lightening goes down the leg. Sometimes I can get away with walking across a room slowly with maybe a 3. Sometimes it hurts so much with each step I can hardly talk myself into continuing. The pain when walking is stabbing.The at rest pain that is low is achy.
Interesting ....
2. Since this began in January I've been taking 800 mg Ibuprofin 3X daily. I have serious all over swelling with it and switched to 7.5 mg Meloxicam last Friday - twice a day. I've tried Tramadol but it seems useless with pain that is not ongoing at rest so that didn't work
Okay
3. I've basically been icing since January, every time I sit down. 20 minutes on. 20 minutes off.
4. I ONLY sit with my legs elevated in a recliner.
and does any of this actually help the pain?
PT for three weeks after difficulty continued after meniscus surgery. It involved daily exercises - ALL were 10 reps each, twice a day. I can no longer tolerate the ones done on one leg and have stopped them.

a. Stand on affected leg with feet forward and together and lift leg good leg about a foot to the side.
b. Same as above but lift leg straight in front.
c. Same as above but lift leg across body in front.
d. Same as before but lift leg straight back.

e. lie on side with good leg bent behind. Keep body straight. Lift upper leg keeping it straight.
f. lie on side with both legs bent and body straight. Keeping legs bent lift upper leg up and release.

g. stand on bad leg and throw a heavy ball into a trampoline and catch it when it bounces back. Do this facing the tramp, then from each side. BTW, this was impossible - I've lost all my core strength.

h. Using a band tied to a pole or slammed in a door, stretch it until taut and then slowly pull leg back.

i. hang heels off a step (to stretch the Achilles)

None of this helped with the pain and now that the pain is worse, most have been abandoned. I have on my own been doing 50 straight leg lifts once a day on both legs because I think it's important to keep my quads strong.
I cannot perceive any of this doing your leg good. In fact, it might even be the cause of it.
Update from yesterday steroid shot in joint. No change even from the anesthetic injected along with it. Also no change from the shot in the bursa - never got pain relief from either the anesthetic or steroid 10 days ago. So, wondering if this means the problem is neither the joint OR the bursa.
Most definitely!
Using a cane helps and I really rely on it to take the weight off my leg.
Have you tried using two canes?
I'm wondering if by allowing myself to not walk with a normal gait when I can't stand it, I'm messing things up more. That biomechanics thing?
Quite possibly.

My assessment is this: that your pain is most likely tendinitis in these muscles, also known as shin splints. Shin splints are injuries to the front of the outer leg. They are medically known as tenoperiostitis of the shin, meaning inflammation to the tendon and muscle tissue attached to the bone and belong to a group of injuries called overuse injuries. The pain associated with shin splints is a result of fatigue or trauma to the muscle tissue surrounding the tibia. The result is an inflammatory response. Read this The shin splint phenomenon
 
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GimpyGal

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@Josephine - thank you for reading and responding to my saga. I read the article on shin splints, too. I would love to have it be shin splints and avoid a TKR. I'm thinking the reason no doctor diagnosed shin splints is that the pain is specifically under the knee and down the inner part of the leg and the front. I have absolutely no pain on the outer side of my knee.

Things are changing, though. I believe the steroid shot into the joint may have helped a little the past three days because I'm back to totally miserable today and was able to function a bit better a few days ago. This truly feels like bone on bone no matter what the surgeon saw in there. *sigh*

Doubt if I can wait even the two weeks between appointments. And, it might be better to get the show on the road - I have the 'trip of a lifetime' mid-March.
 

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Well, it might not be an 'either or' situation. It could be both. But you'll find relief if you go see a chiropractor. They're good at treating that kind of thing.
 
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GimpyGal

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Well, it might not be an 'either or' situation. It could be both. But you'll find relief if you go see a chiropractor. They're good at treating that kind of thing.
I've never used a chiropractor, and I'm open to anything! We'll see where this leads. Thanks, @Josephine
 
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GimpyGal

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Thought I should check back in since @Josephine took so much time to deal with this post. I have not yet seen a chiropractor. My surgeon was not wild about the idea and dismissed recommending one, so I've been trying to find one on my own and all I get are horror stories of who to stay away from! Scares me a bit.

I did go see a new PT after I realized the improvement with the steroid shot was simply wishful thinking. Usually they just listen to my history, look at the Rx for PT and then print a bunch of exercises off their computer and monitor how I do them. I do them at home and come back and they watch me again. And again.

Anyway, this time there was lots of feedback from the PT, lots of questions from him to me, and a good physical exam. I may have a couple of things going on, but by the time I saw him I hurt just about everywhere on that side of my body. He believes the majority of the problem right now is in my fascia which runs from your head down to your toes. It's strained. ???

It feels like voodoo but the technique he is using is Strain/Counterstrain therapy. It's hard to explain but he locates tender spots on my body and uses pressure on them, constricting the surrounding fascia (apparently fascia wants to be constricted rather than stretched) until it releases. It seems so odd because the tender points are no where near my knee. My explanation is probably falling short.

He says some of the fascia areas trigger nerve pain, some muscle pain, others ligament pain. A couple of sessions have made a real difference. The tender points are no longer tender. It's just very weird - I've had tenderness on a certain place my scalp for the longest time - months if not years - and just dismissed it. Now, it's no longer tender.

Voodoo, indeed.

The therapy does not hurt at all, I leave feeling better, although over the next 24-48 hours I'm really sore and achy. I am definitely improving from when I was just hobbling around I still have pain in the medial side of my knee but now it is more localized rather than shooting pains down the inside of the shin.

I've never paid any attention to fascia (other than plantar fasciitis) so this is all new to me. Quite curiously, the plantar fasciitis I've had in the past has also been on that same side, as well as trigeminal neuralgia, also on that side. This could all be related.

I also have some simple stretching exercises and he's doing TENS at a level I don't detect.

If this helps me regain my life I'm all for it. No matter how weird it sounds. Who would have thought fascia would be causing such pain!
 

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Does not sound strange at all. I have fibromyalgia and myofascial pain syndrome. My husband helps me with trigger point therapy. He puts his fingers on a very tender point and applies pressure. After I come down from the ceiling :heehee: the pain is much better.
When examining my knees my OS told me some of my pain was myofascial tender points but there was also the arthritis pain. OS made sure I understood that a new knee would not relieve the fascial pain but definitely gets rid of the grinding bone on bone pain.
 

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Strain/Counterstrain is a wonderful treatment, gentle and pain free.
Here is a link for additional information: http://www.jiscs.com/Article.aspx?a=11
For references click on case studies.
For the pain and soreness you feel afterwards, drink more water, and/or take a warm shower.
 

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If you have trouble finding a chiropractor, look for an osteopath. We have one in my clinic. My internist scoffs at manipulation therapy, too, but he said to go ahead if I wanted it.

I saw him, he did a few things, gave me a couple exercise, and said he couldn't do much more for me until I lost weight, because my biomechanics put me out of alignment.

You've found a gem in that PT!


Jean

LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006
Left Knee Arthroscopy: 10 February 2005
 

Josephine

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I have not yet seen a chiropractor. My surgeon was not wild about the idea and dismissed recommending one, so I've been trying to find one on my own and all I get are horror stories of who to stay away from! Scares me a bit.
Of course surgeon's aren't wild about the idea! A) it's competition and b) they know nothing about it! I would only ask - do you ask your doctor's opinion/permission before you book in to see a dentist?
It's hard to explain but he locates tender spots on my body and uses pressure on them, constricting the surrounding fascia (apparently fascia wants to be constricted rather than stretched) until it releases. It seems so odd because the tender points are no where near my knee.
My dear that's chiropractic treatment ! Perfect.
 
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