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TKR Possible 2nd MUA and possible referral needed

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Re: The next step.... manipulation

Oh gosh! That's a lot for you to take on board. But at least you now know what you are dealing with.
All I can say is that I wish you all the best with this MUA and will pray that you get really good results without too much pain.
 
Re: The next step.... manipulation

Praying for the best Jill! :th_prayer2:

"He really has me expecting the worst... which is the way I prefer things."
I can identify with that.
 
Re: The next step.... manipulation

Jill, best of luck tomorrow!! Make sure you speak up loudly about whatever you may need while you are in the hospital. As we all know, getting the pain med cocktail right from the beginning, helps tremendously!! Please let us know how
you are doing
 
Re: The next step.... manipulation

Jill, good luck tomorrow. I will be thinking of you and sending "bending" thoughts your way. Let us know how you are doing when you are up to it.
 
Re: The next step.... manipulation

Hi Jill,
That is some story. The first thing that comes to mind, you may want to ask him what he thinks about a morphine pump. This can be handled as an outpatient. Also, I hope you and your PT have a game plan worked out so you stay on top of the situation. I feel that in is more important in your case to have activity to your hamstrings. I would have you spend a great deal of time on a stool or rolling chair, scooting around the floor using your hamstrings. Dig your heals in and pull yourself around using the hamstrings. Just from thoughts from the arm chair.
Best of luck,
David
 
Re: The next step.... manipulation

Jill,

Take care and I will be praying for you!:th_prayer2:

You have a rough road ahead from the sounds of things but you are young, (the same age as me:th_heehee:) so I know you can handle it!


 
Re: The next step.... manipulation

Jill, bless your heart....this is rough but we are all here rootin' for you to get through this challenge. I look forward to hearing from you once you are home.
 
Re: The next step.... manipulation

Hi All. Thanks so much for the encouragement and good wishes. I believe I am a bit more nervous about this than I was the TKR itself. My friends and family are great, but I know you all know what I'm going through... and that helps so much.

I'll be in touch as soon as I can after and let you know how I'm doing. Thank you again so so much for your support.
 
Re: The next step.... manipulation

Jill,
Saying prayers for you now that you get the results you need and that the pain will be minimal and soon in the past.
 
I can bend my knee....finally!!!

[FONT=&quot]Hi All,[/FONT]

 [FONT=&quot]First off thank you again for all the support and well wishes prior to my manipulation. Having people that know and feel what I'm going through is an amazing comfort to me. I apologize for not getting on here sooner to report back. I’ve had computer issues and am now back up and running…finally.[/FONT]

 [FONT=&quot]I arrived at the hospital at 6am for my manipulation and was in the OR by 7:20. I had general anesthesia, knocked out, manipulated and was awake but groggy in the PACU a few minutes after 8am. Apparently, my OS bent my knee with "more effort than he has ever needed for one of these before" but got me to 110 degrees! Once I was moved out of the PACU they attached me to a CPM machine and I remained on it constantly and only got off to go to the bathroom. They started it at 70, went to 80 and then I swear the nurse cranked it to 110. Every time it got to the 110 mark the machine held it for 9 seconds and it was SOOO painful, I found myself trying my rhythmic breathing that I learned during Lamaze... and when then didn't work I just plain old held my breath each time. The knee pain was horrible, as was the pain behind my knee where the CPM pushed against me at its greatest flex. After about 4 hours of this they backed me off to 100, and by the next morning I was at 90+. I was given multiple pain meds, with the IV morphine having the most immediate effect, but also the most short-lasting. [/FONT]

 [FONT=&quot]I was sent home on the same dosage of Percocet I had been taking prior to the manipulation, but with a max of 10 per day, instead of the previous 8, and Celebrex twice a day. I arrived home the following day shortly after noon and had a CPM machine delivered within the hour. It is my new best friend and I have strict orders to be on it at least TWO HOURS ON and then TWO HOURS OFF around the clock for at least three weeks. [/FONT]

 [FONT=&quot]I continued with my physical therapy the next day and my PT was happy with what my OS achieved. I was incredibly sore and this PT does NOT believe in pushing a patient to tears… did I mention I love this guy??!!?? He did some stretches, massage, and measuring. I only measured around 73 degrees but by Monday I was up to 85 – there seems to be some discrepancy between the CPM and the plastic tool thingy the PT uses. But my leg is bending for the first time in almost FOUR months… so I’m not squabbling over numbers!![/FONT]

 [FONT=&quot]Now, for all you who have undergone manipulation before me… is it normal to be in God awful horrible pain? My manipulation was last Tuesday (8 days ago) and I’m still looking for my meds every 5 hours. I have a lot of pain behind my knee, but the worst pain (and this is completely new) is when I am OFF the CPM and sitting in my recliner with my feet up and a pillow under my leg – my regular position for 3-1/2 months before the manipulation. The pain is very generalized knee pain – down to the bone – almost a deep horrible painful ache that radiates up the back of my leg to my butt and down the outside of my leg (calf) toward my outside ankle. This pain wakes me from sleep and nothing seems to make it better including ice, position change, etc. [/FONT]

 [FONT=&quot]I have my f/up with my OS on Monday. I know my issues are a bit different than most and even my doctor is at a loss with me and kind of “winging” it. We are still hopeful that my body is able to keep a good portion of this flexion. I do know (and my PT was fearful of this happening) that for what I gained in flexion, I seemed to have, at least temporarily, lost some ability. If I’m standing with my leg a few inches in front of me, prior to manipulation, I was able to lift my leg/foot a tiny bit to put my pants on. I cannot do this anymore. When sitting in my recliner, I can no longer move my leg around at all without the aid of my other foot helping, or the use of my leg lifter. I hope this stuff comes back…but for now I can’t tell you how wonderful it is to see my leg bending. It truly is amazing to me, and even if my body doesn’t hold too much of this bend on a long term basis… I am thankful for what I have right now. [/FONT]

 [FONT=&quot]Okay… shutting up now! This has turned into a mini-novel. Thanks for listening/reading!![/FONT]

 
Re: I can bend my knee....finally!!!

Jill,
I didn't know your story well as I'm one of the newer kids on the block but I went back and read some.
I can't help you with what you are going through now and the questions you have, but I can say that I wish you the best in your healing and rehab in the days to come.:THUMB:
 
Re: I can bend my knee....finally!!!

Hi, Jill.....boy, you HAVE been through some interesting days, haven't you! I'm glad your MUA has provided you with additional ROM. I'm not a fan of that "push until you really, really hurt" routine. I'm sure that's causing you some of your swelling (that results in less ROM). But, I can see that your surgeon definitely has a plan and that extreme movement is part of it. At this point, I think you need to follow what he is telling you to do with therapy and the CPM.

It certainly is possible to have pain following an MUA...especially with the pushing you're doing. So don't worry one little bit about those pain pills. Right now, you NEED them. So continue to take them on a schedule that works. And do not hesitate to talk to your surgeon with any questions or concerns you have. I do think the pain will lessen in a week or two. Your knee has been through a lot and things need to settle down.
 
Re: I can bend my knee....finally!!!

Jill,

Even though you've been doing PT for these four months, none of your leg muscles have gotten any amount of stretch. Plus with your doc pushing hard on the manipulation, that caused one giant muscle strain. That's the Catch-22 of manipulation. The swelling and trauma from the MUA lasts one-two weeks. In your case I would think two. My OS describe it as a 4 step forward 3 backward kind of thing.

I have now had arthroscopic removal of adhesions because my MUA did not have lasting effect on a huge adhesion I had. Only now, three and a half months after TKA, am I stretching my quads.

Sorry you are in so much pain. It seems as if you may need a little more pain med. Sounds as if your OS is fully supportive and will work with you to make you more comfortable.
 
Re: I can bend my knee....finally!!!

Jill, I was also looking for my pain meds every 4 hours following my MUA. It took me a little over 2 weeks to even start to think about cutting back on them
 
Femoral nerve block?

Okay, so the latest goes... I'm holding some of the bend after the manipulation. From a standing position and bending my leg, I think I'm around 60 degrees. If I brace my foot on the ground/against something, or my PT bends it, I'm around 80.

My last visit to my OS 2 weeks ago (2 weeks s/p MUA) was uneventful. He explained in graphic detail how it took the force of his (muscular – my description) 200 lb body braced by another male in the OR to force my knee to bend to a maximum of the 110 degrees, so he wasn’t surprised to hear that I couldn’t do it on my own with my damaged nerves. Other than that, he said and did nothing other than he doesn’t know what else to say or do and that I should continue PT, continue waiting and he would see me again in two months.

Okay… here’s the NEW stuff. I have a past medical history of a 3 level cervical spine fusion (2005 & 2007) with occipital neuralgia as a side effect. In 9/09 I traveled out of state (5 hrs away) to have an occipital neuromodulator (pain management device/computer) implanted. BEST thing I ever did! I traveled this past Friday for my six month f/up with this pain management doctor. He reprogrammed my computer and then we spent the rest of the time talking about my knee.

I gave him a brief summary of everything that has happened. He seemed rather surprised when I told him that I had been told that I had femoral nerve damage most likely as a result of the spinal epidural. One of the many pains I have had since my TKR is a pain from the outside of my knee that travels sharply down the outside of my shin/calf and into my outside ankle and foot. This has been exacerbated B-I-G T-I-M-E since the MUA and the pain stops me in my tracks and wakes me every night without fail around 4am. The pain encompasses my entire knee – all the way around, front and back, and radiates down to my ankle/foot. If I move my leg or foot even the tiniest bit, it gets significantly worse. I have lived with different nerve pains for years, but this one takes the cake.

If I am sitting with my feet on the ground (keeping in mind I don’t get to a 90 degree bend) in front of me, I still cannot bend my leg at the knee and lift my foot off the ground even the slightest bit…. There just isn’t anything there when I try.

My pain mgt doc on Friday seemed more concerned about this than any doctor I have seen so far. He does not like the “wait and see” and feels this kind of nerve pain needs to be addressed and the sooner rather than later. We discussed the tests I’ve had (CT myelogram, EMG/NCS, x-rays) and he wondered why I hadn’t had a femoral nerve block done as a diagnostic tool and why I hadn’t seen a vascular doctor yet. This doctor (who I must add I trust wholeheartedly) immediately emailed my local pain mgt doc (the original one who referred me to this out of state doctor) and got me a consult with him in a couple weeks.

I’ve been reading up on peroneal nerve damage, but all the info I find refers to foot drop (which I thankfully do not have), and doesn’t go into the part about not being able to lift my leg and whether that is related to the peroneal or the femoral nerve.

To say I am somewhat frustrated is putting it mildly. It seems every doctor I talk to has a different take on things. Orthopedic docs say its from the anesthesia when the epidural was placed, anesthesiologists say no way possible for that to happen, pain management docs say the femoral nerve via the spine doesn’t quite fit, GP is confused about everything. All I want to know is what happened and is there anything that can be done to fix me. I feel I’m getting a bit of a run around from my OS, but it could just be because he is completely at a loss as to what went wrong and what to do. All the MDs he referred me to are direct colleagues of his and share office space with his practice. I’m not a cynical person but I’m starting to second guess everyone.

I try to remain with a positive attitude, but I’m confused and feeling a bit lost by it all. I guess I just needed to vent. I was wondering, however, I know the doctor talked with me about it on Friday but I was processing so much, what information would come from a femoral nerve block being done for diagnostic purposes? And is that done in a doctors’ office or outpatient at a hospital? Questions I will ask when I meet with the local pain mgt doc, but I’m just curious.

Thanks for taking the time to read this. Any thoughts would be appreciated.

Fondly,

~Jill
 
Re: Femoral nerve block?

Jill,

Some tests are done as "rule outs." If they do a femoral nerve block and there's no change in your neurological condition, that kinda establishes that it's a femoral nerve problem. Just guessing. Maybe you should call and ask?

The fact that this doc is showing initiative would perk my interest, and I agree, I think this has gone on too long. Certainly there's someone out there who can at least do a better job getting to the bottom of this . . .
 
Re: Femoral nerve block?

Yes, Mary is correct. It's a diagnostic procedure. When they do a block, if nothing changes in your ability to lift your leg or bend your knee, then femoral nerve damage is confirmed. If you find you can lift your foot and/or bend your knee, then the problem is coming from elsewhere.
 
Re: Femoral nerve block?

Jill, through all of this have you seen a neurologist or neurosurgeon? That might be a good place to go for an opinion.
 
Re: Femoral nerve block?

I concur with Jamie---why not have our ortho write a script for you to see a neurologist. That may be a big help in settling what might be the issue here.
 
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