MUA for me...I'm discouraged...and a strange pain

[need2nees]

I may not be following the 'rules' about posting as I think I need to post new questions on previous posts. Please advise, if so.

I thought I was doing reasonably well; started PT outpatient, sleeping through the night, but still (apparently) didn't have a satisfactory range of motion since my LTKR on Jan 27, 2014. Extension at best is 10-12, flexion maybe 100. Dr is concerned that scar tissue from my previous numerous surgeries is playing a part in this, and recommended a MUA within the week. I'm a bit startled and discouraged. I have tried to read all I can about MUA's here on the forum, but is there something in here specifically about the procedure that I should be referencing?

Also, for the past week I have had a recurring and strange pain that I am concerned about. It happens when I first step on my leg and occasionally when I am just sitting, but it is the most painful when I put weight on it. I get a VERY sudden, sharp electrical pain that zings diagonally from the inside of the top of my knee through the knee joint and to the lower outside of the knee. It is so painful and sudden, I gasp in pain and freeze....not able to move until it subsides which is usually 30 seconds or so. Sometimes it is just one 'shock', sometimes it is several. I can't even talk when it happens. How could I have 'electrical' pain through a knee joint that is not my own?? And what might be causing this? I am very fearful that it won't go away.

A bit discouraged, scared about MUA, and can't even think about getting my other knee done which doesn't help. Any thoughts would be appreciated.

 

[Jamie]

@need2nees You are correct that you should be posting these updates and concerns in a single recovery thread. I have combined all five of your threads from the recovery forum into this one. Please do post here from now on. Feel free to tag any of the members or staff if you want a specific person or persons to see your post. And....if you decide you'd like a different thread title at any time, just post what you want and we'll get it changed for you.

7-8 weeks is on the early side for an MUA, but if you really have hit a wall with recovery and swelling is not a problem for you, then it may be helpful to get you going again. Just know that you have the right to tell your surgeon you'd like to try on your own for a while longer if that is what you prefer to do. There is no "window of opportunity" on gaining ROM as some people may tell you.

Is this pain you're having occurring every time you stand on your knee? Have you discussed it with your surgeon and, if so....what has he said about it?

I'm going to tag @Josephine so that she can comment. She will want to know exactly where the pain is, so if you could indicate it by the numbers and letters from the chart below, it would be appreciated.

Can you tell me the exact site of your pain using this chart?

 

[NetballKnees]

Hi Trish ... I have recently moved and do not have internet at home, so haven't been on here much, but your thread caught my eye. Your TKR was 27 January, no? That makes it about not quite 6 weeks? And your doctor wants to do a manipulation even though your flexion is 100 or thereabouts? I am now over 5 months out, my flexion is 80-85 and my surgeon is happy for me to keep making my way slowly. Not sure if this is the right attitude, but I really think he feels I have achieved all I can in the way of flexion. I am more concerned about the pain you are getting and the lack of extension. If the surgeon considers MUA totally necessary and you agree to go ahead with it, if you read through here, members have had incredible results from MUA, so please don't be scared. I think it means you have to be very diligent about extension and flexion exercises afterwards. I am wondering if he also feels that the pain could be caused by adhesions or scar tissue or whatever the hell it is called (still don't understand the difference) and feels that if he can break the adhesions up by way of manipulation, this may also help the pain.

Also, this pain could be caused by perhaps damage to one or other of the ligaments. I have medial cruciate ligament damage to both knees now and the pain can be horrendous, but usually only achieves that "freezing in spot" sensation when (to my description) "some floaty thing gets caught where it shouldn't be".

This post probably hasn't helped at all, but if you (and it is up to you and not your surgeon) decide to have a manipulation, take heart from all the marvellous stories on here of MUA that has achieved great results.

Sending good thoughts your way ...
Ellen

 

[NetballKnees]

Sorry Trish ... only saw Jamie's reply as I posted mine. Jamie's reply is probably much more learned and considered than mine and she has done the right thing by tagging Josephine.

All the best ...

 

[need2nees]

Jamie, thank you for fixing my wandering posts the electrical pain I experience is in regions BLB4 to ERB2. It does not occur every time I stand, but most frequently it occurs at this time. Sometimes it occurs at rest, just out of the blue. The 'electrical' nature of it is what startles me. And, it seems to be deep in the joint instead of at the surface which is puzzling. It does seem to subside when I take a very low dose of muscle relaxant..2.5 mg of flexeril, but I wonder if this is more of a psychological effect. Haven't discussed with OS yet, but plan to. Just wanted some input...

NetballKnees, thank you for your thoughts and sharing..your insight is really helpful!! Good thought about the ligaments..I too have history with those.

Also, as I await Josephine, I wanted to highlight that my OS is more concerned about my 10-12 degree extension rather than my flexion of 100 or so..he is quite satisfied with that. Jamie, as you noted "if swelling is not a problem for you", interestingly the swelling is ABSENT. Even after PT or exercises, swelling is very minimal. I do work very hard at exercises, continue to ice and elevate frequently, take pain meds occasionally (average dosage 7.5/325 norco one tablet one to three times daily) Also starting to do some basic tasks like laundry, sit-down gardening, short walks, extending time I am on my feet rather than elevating. Still need a nap almost daily.

Another component of this is that this knee has been operated on at least 6 times since 1968. SCARY! And..(blast to the past) I recall the treatment in the early 70's was to put you in a straight leg, almost hyper-extended, ankle to thigh pressure cast for 6 weeks following surgery. Is that terrifying or what? This was after 2 incisions about 4 inches long on either side of my kneecap to 'repair' the damage. It's amazing I ever walked after that.

Thanks for all of the help and support. I look forward to insight here. All of you are great!

 

[beth1954]

Forgive me if I haven't been paying attention, but if your flexion is at 100, why does your doc want to do the MUA? That doesn't seem bad at all to me. I am 3 months out from surgery and my flexion isn't even to 90. I mean I have gotten it to 90, but with a lot of brute force. It's probably more like 80-85. I am going to have an MUA this Friday (the 21st) and I'm just sick about it.
Is it the extension he's more worried about? I guess the MUA improves both??

 

[need2nees]

Hi Beth, no apology needed it is the same issue I raised with the OS since I was VERY proud of my 100 flexion. He said it's the straightening of my leg he is worried about, and was very optimistic that MUA will improve this. I can only (with pressure) get my leg to about 4 inches off of the floor. As a result, I cannot walk with any kind of normal gait, because I can't straighten my leg. Apparently, MUA improves both. He wasn't even on the fence about it.

I will be thinking about you Friday.... My MUA is scheduled for 8AM on Tuesday the 25th. I will look for your post after Friday, or PM me. I am SO afraid of the pain waking up...I really had a time of it with the surgery.

Fingers crossed for a good outcome for you...

 

[Bluetechseeker]

I had bilateral MUA's about three weeks ago, my OS said then that extension was much harder to work on during the procedure than the flexion. My right knee is worse, about a 7 or so, the left is about a 2 or 3. Has your doctor given you an idea of the improvement he'd expect doing the MUA?? If he's concerned about scar tissue from previous surgeries, how would an MUA affect that now?

 

[pattymcb]

What is an MUA?

 

[need2nees]

Hi Bluetechseeker, he told me the same...that extension is more difficult to work on, but he was quite confident that the MUA combined with PT will bring my knee to less than 5. We will see!

 

[need2nees]

What is an MUA?

manipulation under anesthesia...check out the 'library' tab at the top to find out more!

 

[Jamie]

Jamie's reply is probably much more learned and considered than mine.....

.

Not at all, Netball.....your comments were just fine!!!!

 

[Jamie]

Have you been doing our exercises to improve your extension? Assuming you are going ahead with the MUA, it would be advisable to do these afterwards. Remember....do any exercises just to the point of discomfort and not to actual pain. You can have swelling in your joint that does not appear when you look it it. The knee compartment is so compact that it doesn't take much fluid in there (swelling) to create a problem with either extension or flexion. So.....please don't try to push yourself too hard at this early stage in your recovery. And 6-8 weeks is still considered "early stages."

 

[Bluetechseeker]

Good luck, Trish! The MUA is no fun but I'm so glad I had them done. I've made more progress in the last three weeks than the six weeks prior to that. AND - far less pain and discomfort now, too. Be prepared, though - it does rather reset the clock and you may find you go backwards at first rather than jump forward. Just give yourself time to recover, rest, ice, elevate and still NO PT that hurts!!

 

[need2nees]

thankyou thankyou thankyou..., bluetechseeker, I will follow your advice!
Jamie, thank you too...and yes I worked very consistently on my extension and really hit a wall at 10-12. No change after that. And thank you for your reminder about still being in early stages. Right you are!

 

[maryo52]

he was quite confident that the MUA combined with PT will bring my knee to less than 5

I had ROM problems. With intervention and gentle bending efforts I was able to get past 90 but the extension lagged at 10 degrees. So I put my husband to work pushing down gently on my knee 10x twice a day. It was delicate because if he pushed too much, I felt burning in the ligaments at the back of my knee and knew that was not good. It seemed as if he'd hardly push on my knee before I had to say "stop." Day after day, I saw no change. But in 2-3 weeks I was able to fully straighten my leg.

No doubt you'll be 0 in a month or two. And the reason I captured the above quote is by way of cautioning that PT is not a cure or a solution, and more PT will not get better results. If done correctly it encourages the body to heal well.

 

[Texan]

Good luck with your MUA! I am sorry you have to go through this but from what I have read, they really are helpful. I hope yours will be very successful.

 

[Josephine]

regions BLB4 to ERB2

I think you need to check this. The LB in BLB4 means left back and the RB in ERB2 means right back! Or are you telling me the pain leaps from one leg to the other!

interestingly the swelling is ABSENT

There is a such a thing as internal swelling which doesn't show externally.

I do work very hard at exercises

Don't like the 'work very hard' bit. More later

take pain meds occasionally (average dosage 7.5/325 norco one tablet one to three times daily

Also starting to do some basic tasks like laundry, sit-down gardening, short walks, extending time I am on my feet rather than elevating

You shouldn't be doing all this at 7 weeks. Have you been doing this much all along?

He said it's the straightening of my leg he is worried about, and was very optimistic that MUA will improve this.

I think 7 weeks is a bit early to be obsessing about extension.

I have some questions to ask you:

1. what 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!

)

2. how often are you icing your hip and for how long?

3. are you elevating your leg, how often and for how long?

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

5. what kind of PT/exercises are you doing? How much and how often? (and detailed details would be appreciated, please! Reps, sets and session and all that)

 

[maryo52]

Jamie asked the same question I had, which is, what have you been doing to improve extension?

I hesitate to counter a plan made between a patient and a doctor, but is it possible for you to give yourself another 2-4 weeks to improve extension before doing a MUA? I had a 10 degree lag, as I said, at month 4 which took 2-3 weeks to eliminate via small, gentle efforts. I hadn't worked on extension before then because it hurt way too much.

 

[need2nees]

Hi Josephine, thank you for taking the time to respond...and SILLY ME for misreading those location charts. Here is the correct locations...LF3C to LF4E! (although the thought of jumping from one leg to the other isn't exactly out of the realm of possibility...my 'jealous' knee, also bone on bone, hurts too!)

Maryo52 I will take time to respond more in depth to your (and Josephine's) questions and insights but not able to until tomorrow..but to both of you I am most appreciative of your time and dedication to individual situations. I feel like I am at home here with friends who really get it! Thank you...and I will be back online with more info tomorrow. Have a great evening