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TKR Possible 2nd MUA and possible referral needed

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Re: Femoral nerve block?

Hi All. Thanks for the responses. No, I have not seen a neurologist or neurosurgeon during all this. Is one recommended over another?? Thankfully, I don't need referrals with my health insurance. I had just been given the name of another orthopedic surgeon (30 miles away from my current OS) to go to for a second opinion, but I will now find a neurosurgeon.

Today wasn't a great day. I find the longer this goes on, the more questions I have, the more I second guess my doctors.... add to that the pain getting worse (actual knee pain and behind my knee/down the side to my ankle/foot)... I have more and more funkier days. I take Percocet 6-8 pills per day for pain (depending on whether it is a PT day or not), but as everyone knows, it has no effect on nerve pain.

Oh well... gotta shake this funky a$$ mood of mine. Thanks again for your thoughts.
 
Re: Femoral nerve block?

Jill, I assumed all along there had been a neuro consult. Argh!!!!

I think your funky mood is telling you that things are not right. I'm betting the neuro will help get you out of your predicament.
 
Re: Femoral nerve block?

I would make it a neurosurgeon if you can, Jill. You still may need to coordinate with a good orthopedic surgeon also, but I think the neuro guy may be of help to you.
 
Re: Femoral nerve block?

Jamie (or anyone)... a question about a neurosurgeon vs. a neurologist -

There are several very reputable neurosurgeons and neurologists in my area. When I look the neurosurgeons up and read their bios, it seems they specialize in spinal disorders, brain issues, etc. Do neurosurgeons see patients for stuff like what I have going on or are they going to look at me like I'm a whacko??
 
Re: Femoral nerve block?

Another vote for a neuto consult. I think even though the neurosurgeon's specialize, they will give you their opinion or refer you to the right area. I hope you have a good day.:flowerysmile:
 
Re: Femoral nerve block?

Difference between a neuro surgeon and a neurologist is this
Neurologist deals with non-surgical issues such as progressive diseases and disorders such as Parkinson's
Neurosurgeon deals with issues treatable by surgery such as brain/cord tumors and cysts and disc protrusions
They are very interchangeable and will readily refer patients to their opposite colleague if they think it appropriate.
So in short, it really doesn't matter which one you go to, if he thinks you need the other chap, he'll say so.
 
Re: Femoral nerve block?

Did someone say that Percocet does nothing for nerve pain?? Don't we perceive pain thru our nerves talking to our brain which is receiving the pain signals from the point of origin? If pain meds don't stop nerve pain, then what does?
I have heard of Neurontin that is prescribed for pain, some say nerve pain, but isn't it all the same?
 
Re: Femoral nerve block?

Because there's a significant difference between nerves conveying pain messages to the brain and nerves that are actually causing pain. Most analgesics work by interrupting the impulses sent to the brain by a painful structure. Others work by preventing the nerve from accepting those impulses. But a nerve that is causing pain because it's being compressed or has had its myelin sheath damaged or destroyed is pretty impervious to ordinary analgesics.
 
Re: Femoral nerve block?

I had a long heartfelt talk with my PT yesterday. He told me for the first time that he feels that even though we have made a tiny bit of progress over the last five months, he feels my problems are probably long-lasting and life-altering and that I should think about seeing (get this...) a neurosurgeon. I told him that "friends" of mine (you guys!) had been encouraging me to do just that.

He gave me the name of two very reputable NS in my area and told me to do everything in my power to get an appt with one of them, and not necessarily a PA or a different MD in the office. He said if there was an issue getting seen, that he would call or that I should have my GP call. I came home and set the appointment up for April 18th... with one of the docs he suggested.

I called my OS today and asked for copies of my OR notes, office notes and test results, as well as copies of my films. Hopefully this doctor can make some sense of what is going on. I need some answers after all this time. And if this is something that might possibly be permanent... I need to wrap my head around that as well.

Thanks again for all the awesome advice.... I feel so lucky to have this outlet and source of incredible information.
 
Re: Femoral nerve block?

I am so sorry that you are going through this, but I am happy that you are seeing a neurosurgeon or a neurologist---perhaps the can answer your questions and hopefully give you the best treatment to help you get your life back on its way.
 
Re: Femoral nerve block?

Jill, sorry that I just caught up with your posts today. I'm so happy you have received excellent advice from all the BoneSmarties and your therapist. Now you're scheduled for an appointment. Well done!!!
 
Re: Femoral nerve block?

Jill, I may have missed something, but have you been going thru this pain since your TKR??? In November? Or since your MUA in February?
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
I kinda think that is a little out of the ordinary, but will leave that thought to Jo or Jamie. I was under the impression that while under the anesthesia there should be some effort used if necessary to push knee down, but since you are not awake you are not aware of pain, so the leg should go down on it's own more or less as far as it PHYSICALLY can. But to have TWO sets of hands aggressively push could in my opinion, cause more problems than cure?!
I too think something isn't quite right, but hard to say if the real issue was from the RTKR or the MUA. It took me since last July to get to 100-110 and that was because, long story short, PT screwed me up 2 months post surgery, so I had scar tissue building, growing like a wild weed in there and the pain was horrible. OS finally went in in Feb to see what was going on and they took out a LOT of scar tissue that was preventing me from moving. While now my issue is extension, not flexion, I still have lots of pain from exercising trying to get a knee to straighten instead of staying bent.
So to me, if 2 surgeons or assistants or whatever had to push you HARD, that is really saying that "HEY! THERE IS SOMETHING IN THERE PREVENTING THIS KNEE FROM BENDING AND YOU GUYS NEED TO STOP BEFORE YOU BREAK MY ******LEG!".... :hissyfit:
MUA is a procedure that is done if they think adhesions or scar tissue have formed that are preventing you from bending, etc, not a procedure that is used to radically put your knee into a position that it cannot go into with gentle pressure.
Am I right or wrong Jo? Jamie?
 
Re: Femoral nerve block?

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
Click to expand...
Actually this simply describes a perfectly routine MUA and I have often been the 'other' supplying the counter pressure. But he it told in a extravagantly scary way to (I think) simply impress the listener! I have no idea why doctors insist on taking something so routine and making it sound like a scene from an Indiana Jones movie! Even the simplest MUA is a brutal procedure just like child birth is a brutal process - especially when they use forceps! More similarities there than you might suppose! :wink1:
 
Re: Femoral nerve block?

EEEWWWW! Sounded like to me they were inflicting terrible things to her! Almost as bad as the knee replacement (well, it sounded bad anyway)!
 
Re: Femoral nerve block?

Thanks for the responses. I have to tell you Jo, when my OS was talking about the MUA beforehand he must have used the word "barbaric" 4 or 5 times. I finally asked him to please stop. He did tell me prior to that MUAs were routine but "barbaric" and said that unless I had a strong stomach not to go looking it up online beforehand.

Margaret - I definitely know the feeling regarding scar tissue. We know my issues started at the time of my TKR. Immediately after I had zero ability to bend my leg, lift my leg or even lift my foot off the ground. I was diagnosed with femoral nerve damage which also meant that not only did I not have the physical ability to bend my leg, it very quickly filled with scar tissue.

After 3-1/2 months we did the manipulation, with hopes that even with the nerve damage I would be able to maintain some of the bend. I too will eventually require surgery for removal of the scar tissue (as well as a knee cap issue where it slips way to the left, also as a result of the nerve/muscle damage), but he doesn't want to do that until we have more of an idea where things stand with my nerve problem.

I hope your issues scar tissue are all in the past and your extension gets better soon.
 
Re: Femoral nerve block?

My OS described his MUA technique as bending the leg holding the upper part of the lower leg (not the ankle -- too much torque) while applying firm (but not too firm) pressure while I lay on the table.

What you had described to you, Jill, would unsettle any of us.
 
My saga continues :(

Okay.... I had my appt with my local pain mgt doctor to talk about a possible diagnostic femoral nerve block. Yesterday, this PM doc had a long talk with the PM doc I see for my neck issues out of state. When I saw my out of state PM doctor two weeks ago, he was very concerned about my knee and the fact that nothing was actively being done to get to the root of what was wrong. He stressed that nerve issues should be dealt with sooner than later, as there is a better chance of recovery if diagnosed early.

Making a very long story (2 hour appt) short.. he and my other PM have now diagnosed me with Complex Regional Pain Syndrome (CRPS) (previously known as Reflex Sympathetic Dystrophy). For pain management purposes he wants to do a series of injections into my spine, weekly for 3 weeks, to see if it helps. I've read up a bit on CRPS and I have to say I'm not feeling so wonderful about this. Below is a brief description.

Complex regional pain syndrome (CRPS) is an uncommon nerve disorder. It causes intense pain, usually in the arms, hands, legs or feet. It happens after an injury, either to a nerve or to tissue in the affected area. Rest and time may only make it worse. Doctors are not sure what causes it.
Symptoms in the affected area are
  • Intense burning pain
  • Extreme skin sensitivity
  • changes in skin temperature: warmer or cooler compared to the opposite extremity
  • changes in skin color: often blotchy, purple, pale, or red
  • changes in skin texture: shiny and thin, and sometimes excessively sweaty
  • changes in nail and hair growth patterns
  • swelling and stiffness in affected joints
  • motor disability, with decreased ability to move the affected body part
  • The pain may spread to include the entire arm or leg, even though the initiating injury might have been only to a finger or toe. Pain can sometimes even travel to the opposite extremity. It may be heightened by emotional stress.
The cause of CRPS is unknown, and there is no cure. It can get worse over time, and may spread to other parts of the body

Each patient with CRPS responds differently to treatment. Spontaneous remission occurs in some persons. Others may have crippling irreversible changes in spite of appropriate treatment. Most physicians believe that early treatment is helpful to limit the disability from CRPS. More research is needed to understand the causes, the development of the disease, and how treatment can alter its course..

I'm still seeing the neurosurgeon on Monday, and I let my PM doc know this and he is completely on board with it and will be faxing today's office notes to the neurosurgeon's office as well. I'm a little taken aback by this today... but am waiting to see if the neuro on Monday agrees or not.

Jo, Jamie or anyone.... does anyone have any personal history or info regarding CRPS? Some of the reading I have done online says there is a better chance of remission if the diagnosis is made and treatment is started in the first 3 months. I'm at 5 months now.

Any thoughts would be appreciated. Thanks in advance.

~Jill
 
Re: My saga continues :(

Sorry to hear of your issues. I saw an ortho yesterday who seems to think I have some nerve issues, but I don't fit any of the symptoms you listed here so I don't think I agree with his thoughts.
Hope you can get some relief soon!
 
Re: My saga continues :(

Jill, we have had a couple of members here on BoneSmart with this diagnosis. But unfortunately they are not active on the forum at this time. I think it can be a challenge sometimes, but I feel you are on the right track to get in there and get started with a treatment.

Please keep us up to date with what is going on. We'll be here to support you. I'm going to tag Josephine so that she sees your post quickly. She may recall more of the details of this problem and how it's handled. @Josephine:
 
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