TKR Fibular Head Pain, Stopping Recovery<

[tcdc135]

@kmak81230--so good to know, you are doing great! I am planning on doing "Ride the Fault" early June "18. Have done it and several others, it's flat and not excessive miles. Just hope I can be ready....now where is that lil red box........;)

 

[Pheebs52]

Pssst: It's under your bed. Don't forget to dab some between your eyes.

 

[cycling67]

@kmak81230 100% agree very humbling! Right when i think i am good suddenly i am not. This recovery is up/down and hopefully in the long run will be more ups than downs.

Thank you everyone for your feedback, i so appreciate all of your words. I will of course keep you updated.

Here's to everyone's recovery!

 

[cycling67]

Request to Administrator: Please change title of this thread to "Fibular Head Pain, Stopping Recovery". Thank you!

Hello to Everyone! It has been some time since I have posted an update. I am in a desperate state right now and am hoping to receive some comfort and maybe some information from this great group of people.

Update: It has been 14 weeks since I had my Left TKR. I underwent a manipulation at week 10 which proved to be very successful. From weeks 10 to 13 I was doing quite well achieving flexion up to 125 and about 1 degree extension on my own with 0 as I pressed down on knee. Strength was increasing and my mental state was improving.

Current: On Friday 11/17 I had a really good day at PT, felt stronger and like I had turned a corner. On 11/20, out of the blue and very acutely, I started having horrible pain near fibular head (outside on the back and below my knee). This pain can be described as a sharp, stabbing, burning pain that radiates down my leg. I go from a 0 on the pain scale to 10+ ONLY WHEN I am in a wrong position. Unfortunately this wrong position is a lot such as walking with normal gait, stepping down from stairs, stepping up stairs, any shifting side to side. As of today it had been nearly a week since this started and I am basically freaking out! I have a doctors appointment with Ortho Surgeon this coming Wednesday to get xray and see what is going on. From web searches (which can be VERY dangerous, it is likely a fibular head subluxation or some muscle or IT Band situation that is affecting a nerve in my leg.

I am unable to do any of my recovery exercises and experiencing other issues because I can't walk normal. Has anyone out there experienced anything like this??? I thank you in advance for any thoughts or advice that you might have. As you can imagine, my mental state is going downhill from a positive outlook to a scared outlook.

 

[Bikesouth]

I have the same problem, started 8 weeks post TKA. Stretching IT band helps but does not cure it. My Ortho said I may be stuck with it for life. I cannot cross my legs in a recliner without going from 0-10 on pain in 5 minutes. If I step down firmly or misstep down off a curb it paralyzes me temporary. I either fall or hop on one leg to regain balance. Cannot stand in one spot for more than 2-3 minutes.

Slowly seeing some improvement but it does not feel like it will ever go away.

FYI I fractured my fibula & it healed crooked so my case is most likely different.

 

[Celle]

I'm going to ask @Josephine to advise you, cycling 67.
Josephine, the problem is described above, in Post #84.

 

[Josephine]

Can you indicate the site of your pain for me using this chart?

 

[cycling67]

Josephine: Based on the diagram it appears my pain is in the LB4 D and LB4 E area. Specifically the pain is at the fibular head area and is only initiated with specific movements like walking with a normal gait (thus i am limping and dragging through with hip), stepping down stairs or lifting to go up. the pain is very grabby and burning and immediately subsides when out of that position. Seems like a nerve issue to me maybe brought on by tight muscles?

I guess my biggest concern is how quickly this came on without any specific reason (that I know of). One day was doing quite well, next really bad.

I read your thread and see you dealt with some nerve issues as well as tight muscles. I have considered going to the Chiropractor and a massage therapist. I will see Surgeon this Wednesday and validate join is OK. I also noticed from your recovery thread the roller coaster of recovery with good days followed by bad days. SO TRUE! I am feeling like this is an actual issue and not just a down day (s) but of course not sure.

Do you have any initial thoughts?

 

[Josephine]

Okay, I got it. But there are many structures other than nerves that can cause this. And your description of trigger activities tells me it's most likely the IT band, the lateral retinaculum or the lateral collateral ligament. The best treatment for it is rest and pain meds.

 

[cycling67]

Thank you Josephine! I am certainly resting (begrudgingly), elevating, icing with ice massage direct on area. The Surgeon cut me off on pain meds so am doing Motrin and Tylenol alternations. I will ask about another Rx of pain meds during appointment this Wednesday.

Do you feel massage is a good idea?

This is just so frustrating I can hardly stand it. Digression really makes me sad. For me it is hard, when something like this happens, to not fall apart.

 

[Celle]

This is just so frustrating i can hardly stand it. Digression really makes me sad. For me it is hard, when something like this happens, to not fall apart.

You do realise, don't you, @cycling67 , that it's only just over three months since you had major surgery on your knee? Recovery from a knee replacement is a year-long project, so you are only a quarter of the way there.

This recovery is a marathon, not a sprint, so you need to pace yourself - and dig deep into your store of patience.

Your knee will be OK, but it needs time, to recovery fully. It's still a work in progress, not the finished article.

Relax, and give your knee a rest for a few weeks. Treat it to more rest, ice and elevation. Something has upset it and it needs time to settle down again.

 

[cycling67]

Thanks @Celle, i know you are right, just having a hard time settling in. I see others in PT surpassing me and feel i should be further. Yup nothing good can come from comparing oneself to others.

Why is it that when i feel like this i end up thinking this is how my life will now be. Good grief! I need some counseling.

 

[Celle]

Why is it that when i feel like this i end up thinking this is how my life will now be. Good grief! I need some counseling.

Just remember that where your knee is now is not where it's going to end up. It has heaps of time to continue to improve, and I'm sure it will.

 

[Josephine]

so am doing motrin and tylenol alternations

You haven't said how much you are taking of each or how often which is very important information.

Besides which Motrin is just ibuprofen and makes a pretty poor pain med. Plus it has some bad side effects Medications: acetaminophen (Tylenol, paracetamol) and NSAIDs, differences and dangers.
As for the Tylenol, it's very underrated as a pain med and even one of the best on the market BUT you have to take the proper dose which is 1,000mg 4 times per 24hrs. Take less and it just doesn't work.

Do you feel massage is a good idea?

Not at all! In my experience, it often causes more pain than it resolves.

This is just so frustrating I can hardly stand it.

I know. It can be frustrating but as Celle said, it's not forever and it's best if it's going to get you a good outcome, is it not?

 

[Clipless]

I had some "grabby" pains behind my knee after RTKR, so sharp I would gasp and stop in my tracks. My OS said, "irritated tissues" and really that's all it was. I hope you get similar good news from your OS.

 

[cycling67]

@Josephine: Thank you for your thoughts and yes I only want the best outcome and if the best means I need to be more patient then that is a good thing. sometimes easier said than done but 100% agree. OK on the massage thought.

In terms of the dosage of Ibuprofen and Tylenol. Here is what I have been doing. Morning and late afternoon I take 800 Mg of Ibuprofen. In between (typically only twice a day) I take two extra strength Tylenol which I believe would equal (single dose of 1000Mg) a total of 2000Mg in a day. With what you are saying, this might not be working as designed in order to assist with pain. Drat... Clearly I need to re-evaluate.



Thank you @Clipless. I also hope this is the kind of outcome from my appointment today. I will update the group as soon as possible with hopeful answers provided by my surgeon. I feel lucky as I 100% trust my surgeon to help me get to the bottom of this. All my best to each of you!

 

[jaschembra]

Were you able to see your OS today? Any word? I hope you were able to get some news to put you at ease. I totally know what you mean when you say "counseling". If I don't watch it, something can lead to this or that and I can have myself talked into having a bad problem. Then I come back and just tell myself this recovery has so many different little issues - it's all part of the journey and I might as well sit back and take 1 day at a time.
I had really bad burning and stinging pain in the area you describe (had it for months, anytime I was up, especially going down slopes and general walking around. I just thought it was part of my recovery). It ended up being diagnosed by my OS as Patella Tendinitis around month 9. In just a couple PT visits, she broke up some scar tissue or something that was impeding on that patella tendon and the stinging/burning went away.

 

[cycling67]

Hello to everyone!

So i saw my OS today. All xrays look good, joint still solid and fibula is ok. Surgeon feels that i have "angered" the peroneal nerve with either tight muscles or potentially too mych extension stretches.

He was wonderful and listened and provided a plan: I am switching to Aleve to help stomach, Tylenol as needed, prescribed Amitriptyline which is a nerve medicine and bonus a mood enhancer, he also prescribed Tramadol. I am to continue PT and do items that cause no pain. The plan seems good based on symptom. I am hopeful it will help and happy that I have a plan. He wants to see me again in two weeks. I love how engaged he is in my recovery, very different than prior OS.

@jaschembra thanks for your thoughts. Getting down is SO easy to let happen, I will work harder at staying positive. I am not sleeping which just doesn't help at all. Both of these meds can cause drowsiness so maybe i will sleep.

 

[Josephine]

Surgeon feels that i have "angered" the peroneal nerve with either tight muscles or potentially too much extension stretches

Wasn't that pretty much what I said earlier?

I am switching to Aleve to help stomach

Aleve is an NSAID so it most definitely won't help your stomach. However, it's not as fierce as ibuprofen.

he also prescribed Tramadol

You haven't said how much he has suggested you take and how often. This was a routine I worked out for my first knee. It's just a suggestion. Feel free to tweak it as you feel fit but notice the use of Tylenol (paracetamol) too. Tramadol works very well when taken with Tramadol.

I am to continue PT and do items that cause no pain

Just make sure you don't do anything that causes you pain, either at the time or hours or days after.

 

[Bikesouth]

Amitriptyline will make you drowsy & help with sleep. It may give you dry mouth & constipation. Be very careful taking it with Tramadol.