Tibial Plateau Fracture Pain when learning to walk again

[Jockette]

You might benefit from reading recovery threads from others who had Tibial Plateau surgery:

Knee Surgery Recovery Area

For post-operative knee patients, on the "other side"

bonesmart.org

 

[Night Owl]

Pain in the evenings may mean you are doing too much. Recovery can take a while so please be kind to yourself and speak to your doctor if you are unsure.

 

[Rockgirl4]

I tend to end up taking an oxy by 7-8 pm every day too. It's like the discomfort or swelling builds throughout the day to where I just can't make it to bedtime and sleep it off. I'm not sure about the tingling though. Hopefully someone else will jump in and help soon.

 

[Tobysmom]

I reread everyone's posts so often. I really can't believe how much pain I feel every afternoon and especially evenings. I elevate and rest all day, only do PT 3 times a week and nothing more lately. I see my doctor next week, but I expect no answers. They say the pain goes away, but I'm finding that impossible to believe at this point. After a month of full weight bearing, shouldn't the pain start to diminish? When did it finally do so for others?

 

[Layla]

I am so sorry you're struggling. Sadly recovery takes time and lots of patience.
Here is a link to threads of those that experienced MUA also -

Knee Surgery Recovery Area

For post-operative knee patients, on the "other side"

bonesmart.org

I hope you have a good visit with your surgeon next week. Write down all of your questions so you don't forget any while you're there. Best Wishes! Let us know how it goes.
@Tobysmom

 

[Night Owl]

PT three times a week is great as long as it isn't pushing too hard especially after a MUA. I had increased pain for weeks after a too intense PT session and will no longer engage in anything that will push my leg to that point.

I do find moving more and not pushing to the point of pain is the best approach for me. Gradually building up to more walking and day to day activities are good examples. Honestly, I had significant pain for a while. Provided your doctor is happy with progress, it takes great patience to recover from this sort of injury. Sending you a hug.

 

[Tobysmom]

thank you for responding, it helps so much. I just can't guage anything, and having some idea of how long this level of pain might be would help. I'm a month into full weight bearing, they want me to go back to work....I don't know what to do. Other than the feedback from all of you, I feel like I'm not supposed to be in pain for long, or should be able to take it.
Any rough idea as to how many more months? I'm basically bedridden and icing all day again.

 

[Jockette]

I'm basically bedridden and icing all day again.

I wonder if you might benefit from getting a second opinion. They can be hard to get, as some doctors don’t want to see someone else’s patient during the first year, but I think that might mostly apply to TKR patients. It might be worth trying, though. While I’m sure this is a long, and tough recovery, I really don’t think you should be in this much pain, that you are bedridden with it, at this point.

I also looked at the other members who had your surgery, and none of the others had an MUA.

Sending lots of hugs.

 

[Layla]

Hello Tobysmom,
I am very sorry you're bedridden and in so much pain.

Another consideration for you may be an online consultation with HSS, Hospital for Special Surgery, which is the top rated orthopedic hospital in the country. They are located in NYC, with other east coast locations, but will review cases remotely. I will include the link. HERE

Again, so sorry you're going through this. I can only imagine how difficult it must be. Please know that we're here for you always, you're never alone here.
@Tobysmom

 

[EalingGran]

While I’m sure this is a long, and tough recovery, I really don’t think you should be in this much pain, that you are bedridden with it, at this point

Agree with @Jockette that if the pain is so bad that you are pretty much bedridden- then I think a second opinion is warranted. Unless you can get definitive reassurance from your surgeon next week.
Have a look at the Oxford Knee Score here on BoneSmart and also maybe do some pain scores at different times of day/ activity before you see your surgeon. It might help to make it clear how incapacitated you are and help them to understand the severity of your issues. Also take someone with you. I find if I am anxious I can get upset and not necessarily advocate for myself well.

 

[Jamie]

I have read through your entire thread and it does sound like you and possibly some on your medical team have been pushing a bit hard on your recovery. Many times the pain from a fracture can be worse than if you had a knee replacement. People don’t realize this and often think of the fracture repair as a more “simple” procedure. Maybe so in terms of length of time for the surgery and what is done, but there can be significant pain for some time as the fractured bone heals. Add in therapists pushing on your knee, an MUA, and you trying to have somewhat normal days….and the result can be continued inflammation and pain.

Frist thing is to give yourself some grace in this healing process. Fight anxiety and guilt! You have been through major trauma. You are totally dependent on your body’s schedule for healing. It cannot be rushed or pain worked through. Your body will signal what it needs and it’s your job to respond accordingly. No one knows your body better than you. When you get increased pain, it means your body isn’t quite ready for that level of activity just yet. Yes, there will be pain at some level as you’re putting increased weight on the fractured an healing bone, but if you notice a definite increase to the pain following something you do, that is a signal for you.

Pain causes inflammation and often swelling. You may not even see the swelling as it can be internal within the very small knee compartment. Left untreated with something to relieve the pain and inflammation, your body can get into a cycle of steadily increasing pain and inflammation. Keeping some type of pain medication…even if it’s just Extra Strength Tylenol….in your body at all times throughout the day and night can help. Sometimes it also helps to add an anti-inflammatory medication as well such as Advil or Aleve, if it’s okay for you to take NSAIDs.

Your first order of business is to get your pain under control. Rest, icing, and taking something for the pain on a set schedule is important. But you should not be in bed all day under any circumstances. You need to be up and walking around at least 5 minutes every hour or two. If you need crutches or a cane to do this more easily, use them. You can decrease their use later as you get stronger and the pain begins to decrease. I would recommend you stop therapy at least until you see your surgeon this coming week. Remember the effort involved with therapy all counts…..getting ready, the drive to get there, the therapy session, and the drive home again. It’s a LOT! Just do some gentle bends and stretches throughout the day and night to keep your knee loose. Right now you don’t want anything that makes pain worse.

Then when you see your surgeon, initiate an honest conversation with him about what you’ve experienced. Insist on his specific input on your pain and activity levels. His responses will provide the basis of additional help we may be able to give you in terms of additional opinions or what to expect in the next couple of months.

 

[Tobysmom]

thank you everyone. I'll update after I see my surgeon next week and I'll bring my husband to help advocate for me. I'm prone to crying these days.

 

[Jockette]

I'm prone to crying these days.

Most of us would be prone to crying, going through what you are. It’s especially common after such and injury and surgery:

Post op blues is a reality - be prepared for it

Post op blues is feeling depressed, weepy, nervy, shaky, fearful of the future, anxious, overwhelmed by what is happening to you, convinced it's never going to get any better and finally, uttering that most intense of all cries "I wish I never had this done!" It arises out of a variety of...

bonesmart.org

 

[sistersinhim]

I elevate and rest all day, only do PT 3 times a week and nothing more lately.

One thing to consider is that having the MUA a couple of months ago, followed by PT three times a week is keeping your leg inflamed. The MUA causes a setback in recovery. I suggest stopping all PT and let your poor leg settle down. You should see less pain after that.

 

[Tobysmom]

I saw my surgeon today. xrays pleased him, and I was quite surprised when he said that I may not get more than the 120 ROM (PT measured yesterday, but this was a painful stretch). PT wants to push for more ROM...just another example of getting mixed messages. I asked about the increase in pain/swelling/heat in knee area over the last 4 weeks, since weight bearing was started. He suggested a cortisone shot into the knee, which I accepted today. He said it should knock my pain down quickly. I just want to control this pain, shake some of this depression, and maybe get back to work in December.

He could not predict how well I will do over time, and mentioned that I may even need a TKR in the future. I know he can't promise what I want to hear, but I got the sense from him that I am not going to improve much or be able to take my former daily long walks, or even know how much this horrid limp will abate. I'm trying not to think about all that too much now... just focusing on pain reduction. He did give me more oxy, with lots of forewarning. I have only been taking ONE per day, not even every day, and always in the evening when I could not take it anymore. I am also taking Meloxicam (one 15 mg daily).

I will listen to my body and NOT push recovery, and maintain gentle movement/walking until I feel I can do more, right? I do think I pushed it 2 weeks ago. Does anyone have any feedback or experience regarding the cortisone shot I got today?

I have gotten the most and best support and information from all of you. I cannot thank you all enough.

 

[mendogal]

My thoughts...
Your surgeon sounds eminently reasonable although it's very possible that "tincture of time" will indeed result in slow increases in ROM.
Any PT who is pushing for more ROM is actively undermining your healing and deserves to be fired. Yes, you can.
Many of our members have benefitted from a single cortisone shot at this safe timeline post surgery.
And, yes, you do seem to be on the right track.

 

[Jockette]

I agree, your surgeon sounds very reasonable. Maybe his prediction for the future is on the cautious side, so as not to disappoint you. Better that, and you improve more, than to have higher expectations that might not be met. And, 120 is a great ROM, which should allow you to do all you need. It’s not the number, it’s the function, that is important.

Do remember, this is a long, slow recovery. Where you are now is definitely not where you will end up.

Granted, my PKR is totally different than the surgery you had, but, after a difficult first year of healing, I had a lot of improvement in ROM and overall comfort in my second year, as my whole leg continued to relax and heal. I have confidence that you will see the same. Sending lots of hugs.

 

[Rockgirl4]

When I hear a PT says they "could" get your more ROM, right after a DR says "this is probably it", my first thought is stop going to PT because he just wants your money (or your insurance company's money). That may sound cynical, but I've experienced it too many times and hate the way they make us question ourselves and/or our doctors.

I am so sorry you are still hurting so much, and I truly hope that a lot of rest can calm things down for you.

 

[Layla]

I have gotten the most and best support and information from all of you. I cannot thank you all enough.

We thank, YOU, for sharing your journey with all and documenting your recovery here for the benefit of others.
Your plan to not push, but take it slow and easy will hopefully get you to where you want to be.
Wishing you all the best, Tobysmom

 

[EalingGran]

will listen to my body and NOT push recovery, and maintain gentle movement/walking until I feel I can do more, right? I do think I pushed it 2 weeks ago.

I think that is absolutely the right thing to do. Listen to your body and just move and walk as much as you can without significant pain.
Your bend may well gradually loosen and improve naturally and I would strongly resist any pushy physio whilst you are experiencing such pain.