MUA Getting Back in the Saddle

[My way]

Hi Alison I hope all went well.
Wanda

 

[HorseyLady]

I'm back home! Had a MUA plus Arthroscopy to remove scar tissue under a general anaesthetic. Saw my OS afterwards who said there was a mass of scar tissue which he has removed and he got me to 120 degrees in theatre. He has prescribed "intensive physiotherapy" because "it will want to grow back" and confirmed his diagnosis of arthrofibrosis.

Within 5 minutes of being back on the ward I was put on the cpm machine. Initial setting was 75 as it was so painful but after 30 minutes they gave me liquid morphine and set it at 90, saying that was what my OS requested. Very sore and uncomfortable overnight and I did not sleep a wink! Not all my knees fault though, I shared the ward with 3 snoring "wild boars"

Stayed on machine until lunchtime then I was discharged. I am walking with one crutch as feel sore and achy. My knee is all bandaged up which I have to remove tomorrow and have to have stitches out in 10 days time.

Bit confused with meds. I was on Tramadol before this operation but have come home with paracetamol (tylenol?) and Naproxen which I have never taken before today but seemed quite effective in hospital this morning and was told is good for "scar tissue pain".

Now I feel a bit tearful and not sure what to do with myself! I want to rest as so tired but should I be on my cpm? Doing exercises? I feel terrified that it is going to stiffen up again as for the moment feels very nice and loose and "released" and my OS has really worried me.

PS How do I add MUA to my thread title?

 

[new knee in June]

Dear Alison,
So happy you are now home & resting it sounds like this was the right surgery for your problem ( scar tissue )
Did your surgeon give you a written prescription for the c.p.m machine (how long & on what number to keep
It on ) ? Do you have a nurse coming to the house or therapist? Sorry about all the questions
You just rest today....sorry about the snoring boars.... 120 sounds pretty fantastic.
Glad you are back
Thinking of you always,
Diana

 

[HorseyLady]

Thanks for thinking of me Diana No, my surgeon has not given any prescription for any specific actions for me to take, other than "intense physiotherapy" from the Rehab team. I have rung them and told them I was home but I don't think they can see me until at least Tuesday. I guess this is why I am feeling a bit lost - well that and the effects of the anaesthetic

 

[puffin]

Hi Alison
Happy to hear that you are home again and that the doctor feels that he has improved the situation - 120 is a great ROM - but obviously you won't get that back until the swelling/bruising from the procedure and adhesion removal subsides

I think that perhaps it is a good thing that the rehab team is not coming until next week after the Bank Holiday(you never liked them anyway and they caused you pain before). So it is probably a good thing that you have a few days to recover. Just do some gentle stretching until they come - heel slides, ankle pumps and sitting bends/stretches - and just aim to keep the knee moving gently

Remember as well that you should still follow the mantra after a MUA with the resting/icing and elevating as the knee will be bruised after the procedure. Oh and don't let that rehab team hurt you when they come - discomfort but no pain

Take care and I'll catch up with you next week

 

[new knee in June]

Good morning Alison,
How are you feeling today I agree with puffin :iagree: now, is the time to follow the bonesmart " mantra"
I hope you are happy with your decision & have a great recovery.
Thinking of you always
Have a wonderful Sunday,
Diana....June sunbeams resting & going forward.....

 

[HorseyLady]

I've had a quiet day today resting and elevating my leg but I did do some gentle cpm as I can feel my knee stiffening up already. Yes it is sore and achy and feels very bruised. Unfortunately I am still very tearful today and every little thing is upsetting me. Just feel like I want to be on my own away from the rest of my family as they are saying all the wrong things I am sure this is just the effects of the anaesthetic.

Josephine Please can you tell me how to add MUA to my thread title instead of TKR? Also any advice you might have on stopping scar tissue growing again? I am terrified that I am going to go back to where I was. Is Naproxen with Paracetamol an appropriate painkiller and can I add back in my Tramadol which I was taking before MUA?

 

[My way]

Hi HorseyLady Oh you poor thing! Of course you feel sore and down. I think the pain is what is causing your mood. I'm not an expert but I think you need something stronger than what you are taking. If you were able to take Tramadol before your MUA there should be no reason you can't take it now if they didn't add any more meds that you weren't on before. Why not give the hospital or your pharmacy a call and ask them.
Wanda

 

[Bionic woman2]

I'm glad you're back home and your OS was able to remove the scar tissue. I hope that you're given a P/T w/some knowledge of what exercises are best for you. May they be compassionate too!

I'm feeling you on the teary eyed thing. It can't be easy and family members don't always have the "right words." My son said something yesterday that set me off. I called the Whambulance and planned a pity party... nobody showed up.

I DO hope that this surgery is all that you will need and your knee will heal as uneventful as possible.

As far as the scar tissue goes, I'm no expert, but I keep hearing Josephine saying that "intense P/T creates scar tissue." I may be wrong, but she'll correct if I am.


Get plenty of rest and try not to worry too much. If you have Netflix, Hulu, or cable, maybe you can find a bunch of movies about horses. You may not be able to ride yet. but you can use your imagination.

 

[Josephine]

Also any advice you might have on stopping scar tissue growing again?

I see you've had this before so I can understand your concerns. However, reducing the possibility of adhesions (not scar tissue) is a bit of a balancing act. On the one hand, you need to keep the limb moving but on the other, it shouldn't be done to excess as this causes the muscles to get hot and overheated muscles have a tendency to develop adhesions. This is what adhesions look like

Is Naproxen with Paracetamol an appropriate painkiller and can I add back in my Tramadol

The Naproxen is and NSAID and, as I have been at pains to frequently say before, NSAIDs are at the lower end of the scale for pain management. The real pain killers are paracetamol and Tramadol. Take them together up to 4 times a day. I don't know exactly what your GP has prescribed but it's usually in the order of 50-100mg Tramadol between 4 and 6 hours apart. Four of those doses can be with paracetamol, the rest without. I mixed and matched them in every conceivable way after my TKR!

 

[HorseyLady]

Thank you everyone for all your best wishes and advice. It is really really appreciated as at the moment I just feel so alone with this. Coming on here is giving me some much needed friendship and support from people who know and understand. My family are trying to be helpful but I have 2 grown up sons (27 and 24) who still live at home and think I just need to "man up" and "push through the pain". My husband is very consoling and is taking care of everything practically but doesn't really know what to say. He is taking me to see the horses later, just for some cuddles which will be nice

I had a good nights sleep but my knee is very stiff and not bending this morning so I have taken a painkiller cocktail (thanks Josephine!) and added back my Tramadol - and had a session on the cpm machine. I got to 85 eventually and was on for an hour or so but then my knee started to get very hot so have come off it now for some resting time.

maryo52 do you have any advice for me? I know you have arthrofibrosis and had arthroscopic removal of scar tissue too.

 

[maryo52]

Hi dear,

You are not alone. I'm here. It's my fervent wish to help you succeed. Your saga reminds me of my own victory and renews my appreciation of where I am today.

I did not have MUA during my arthrolysis so I did not have your level of discomfort and swelling afterward. But it was probably a good idea. They cannot get up into the quad enough to get all the adhesions (such as those shown in Jo's illustration) so your surgeon used the MUA to break what he could not remove. BTW I had a 1/4" cord tethering my quad to bone, so you see arthrofibrosis is in a category beyond simple adhesions. My arthrofibrosis was so pervasive it had grown into the femoral notch.

Most of all right now you have to balance rest with moving your knee as effortlessly as possible through the range of motion (the CPM is good for this) so that you are always "patrolling" your ROM but not causing inflammation.

Definitely err on the side of rest right now. It is so so important to get this inflammation settled down. Your primary goal, in fact, is to minimize inflammation. Your second goal is to keep range of motion WITHOUT PAIN. So you have to let go of ROM goals. This biz makes us goal oriented and that's precisely what will stir up the arthrofibrosis. NO PUSHING!! Arthofibrosis thrives in that environment. You will do best if you just give up measuring and learn to eyeball and feel your bend.

After a couple of days start incorporating GENTLE stretches. Stop the stretch when it feels uncomfortable and hold 30-60 seconds. If you stretch to a point and it hurts, back down a few degrees until it is 3 or below on the 0-10 pain scale. Ice well afterward. I combatted inflammation with rest, icing and elevation, and NSAIDs. That's why they want you on Aleve. BTW I quit PT before my arthrolysis and am so grateful my ortho supported my decision. He is not a big PT fan anyhow.

I was 95 on the table which bummed out my ortho. He said I'd be lucky to keep 90. I gained my ROM very very slowly over weeks. I think it was 4 weeks before I hit 90. My situation wasn't hopeless but it seemed hopeless and I sought a second opinion in that first four weeks. That ortho seemed no more hopeful than my own. Just prepare yourself to not see results for some time. Hope for the best, prepare for the worst!

Do not add strengthening exercises until after a month has passed and you have gone beyond 90. Why? Strengthening exercises are not needed and will only stir up inflammation.

Once I was past 90 I drew 100, 105, and 110 degree angles on a piece of paper, and while bending my knee as much as possible without pain, asked my husband to point to whichever angle it looked like. (It helps to have husbands who can lie a little!)

Arthrofibrosis is a bear. It causes thickened synovium so there is more synovial fluid (my thickening and excess fluid is chronic).

Please do not hesitate to tag me if you need encouragement or guidance.

 

[new knee in June]

Good morning Alison,
I hope you are feeling a little better today isn't it great to have Mary & Josephine to guide you through
Your recovery ? I hope they have helped put your fears at ease your husband sounds wonderful & caring.
Slow & steady.....wins this race, have a peaceful time with your " babies " today, they will be so happy to see you.
Thinking of you always,
Diana

 

[HorseyLady]

I agree Diana. Having support from people who have been there is worth its weight in gold. Thank you for thinking of me, your friendship and supports means so much

maryo52 thank you so much for taking the time to give me so much information about what to expect and what to do. It is so useful to hear your view as all I am hearing right now is PUSH PUSH PUSH. I was told today by the PT that I have to grit my teeth and bear the pain because the cpm must NOT be set less than 90. Yes, I was getting 90 in the hospital but I was on morphine! It is not so easy at home and several days on when I can feel things want to stiffen up. The Tramadol doesn't quite cut it! And as well as a minimum of 4 hours a day on the cpm, they have added so many exercises to my programme that I will be spending all day working on my knee if I do what they say

Bit of an emotional wreck today. My friend's foal died this morning aged just 10 weeks. She was the most beautiful little girl and was born the day after my TKR. They sent me pictures of her in hospital to motivate me to get out and come and visit her. So very sad.

As for the knee, still feeling a bit battered and bruised and the incisions and stitches are sore what with all the bending. Have changed dressings twice as I am getting blisters again like I had with my TKR wound. It all seems a bit hopeless at the moment

 

[maryo52]

It must be tough to say no to these folks urging you to do more exercises. But it will put you back into the vicious cycle that got you here. This is a tough time, and I can imagine how much more painful it was for an innocent beautiful foal to die. Maybe Josephine has some insight about the blisters.

 

[Josephine]

I got to 85 eventually and was on for an hour or so but then my knee started to get very hot so have come off it now for some resting time.

Don't let your knee get hot from exercising because, as I said in my last post, hot tissues have a much increased tendency to develop adhesions.

It is so useful to hear your view as all I am hearing right now is PUSH PUSH PUSH. I was told today by the PT that I have to grit my teeth and bear the pain because the cpm must NOT be set less than 90.

Well your PT is wrong - very wrong. Do not ever do anything that moves you beyond discomfort.

And as well as a minimum of 4 hours a day on the cpm, they have added so many exercises to my programme that I will be spending all day working on my knee if I do what they say

Good grief! Talk about overkill! I hope you don't do all of them.

The Tramadol doesn't quite cut it!

Why is it not working? How much are you taking and how often? Are you taking Tylenol with it and how much, how often? On the other hand, if you are attempting to comply with everything your PTs are demanding of you, I doubt any pain med would cut it!

 

[puffin]

Hi Alison
Just catching up with your thread now that I am back from Ireland. Sorry that you are in so much pain and feeling a little despondent.

Don't let the PT bully you into doing too much and being in pain - they were totally wrong last time (remember they told you that your ROM would improve by "pushing through the pain" when all of the time you had adhesions?) - so just do what you feel is enough. Remember that most people's ROM goes down from where they were in hospital in the first week owing to the bruising and swelling from the procedure

A few weeks ago I had extension problems and the hospital PT was adamant that I should be pushing on my knee to force it down which just led to more pain and swelling ... My local PT told me to forget about those exercises and not to force anything and a week later I was at zero

Take care and follow the mantra

 

[Bionic woman2]

It all seems a bit hopeless at the moment

Sorry to hear about your discomfort and low spirits. I remember in the beginning when I had to do the cpm machine for 6 hours and my p/t exercises 3x a day! I told my in-home p/t that I was spending the whole day on my back (without and pleasure I might add! ) The only time I got up was to use the bathroom or eat something.

I hope things start looking up for you and you find something to ease the pain.

 

[new knee in June]

Hello Alison,
Any better today ? I think you need to call your os for stronger pain meds. No need for you to be in pain.
When I used the cpm I iced while I was in it. Maybe this would help with your knee not getting hot ( like
Josephine said ) it would help with the pain
I feel so sorry, you must be confused with the work through the pain & the bone smart way. Two totally different
Views
I just wouldn't let them push you to pain, listen to your knee & you won't go wrong.
You know your body best
Take care,
Diana....June sunbeams one day at a time.........

 

[HorseyLady]

Bionic woman2 thanks for your post, you made me laugh about being on your back Yes, there is not much pleasure to be had from the cpm. I have found listening to music is probably the best way of coping with it.

puffin thanks for your best wishes and glad you are safely back from Ireland. You are right about the Rehab team of PTs, they do cause me pain and they continue to tell me to push through it. I am doing as much as I can but nowhere near what they say I should be doing!

Josephine I seem to be getting used to the Tramadol and it is not as effective as it was. I started Tramadol when I had my TKR so wondered if 10 weeks of it was too long and my body is used to it? It was effective at first. I have been taking 2 paracetamol plus 1 50mg Tramadol at breakfast, lunch and tea - then 2 paracetamol with 2 Tramadol at bedtime. Then the hospital said take Naproxen so I replaced the breakfast and tea Tramadol with 2 Naproxen, still with 2 paracetamol. This doesn't help the pain much at all., certainly not if they want me to "push" my leg. You might be right, maybe I am expecting too much of any painkiller to stop all pain when using cpm at the settings they want me to. Is there a painkiller out there that would let me set the cpm to 90 and kill all pain in my leg???

Bit better today emotionally wise. I am hoping the effects of the anaesthetic are now leaving! Still very concerned that I am not making as much progress as I should be but I have been told that progress is slow after MUA so I don't know why I continue to beat myself up. It just seems soul destroying to have had a MUA and scar tissue cut out and still not be able to get near 90 for myself!