TKR Sarah Jane's Summer Journey and Fall Frolic

[SarahJane]

Would you mind giving me a little medication advice, @Josephine? My dramatic pratfall -- details in post #355 -- onto my new plastic kneecap was accompanied by my upper left shoulder crashing into the door frame as I went down. It feels like I've got myself some bursitis going on in my left shoulder. I had bursitis once before, and was told to take ibuprofen for it. But I've been taking Aleve twice a day to help with the swelling. I've been icing it for 45 minutes at a time about 4 or 5 times a day, and keeping it level or slightly elevated. It's not very happy. I did treat myself to a bath, but it was a little more difficult to get in and out of the tub because of the knee's swelling.

I do have some Percocet left, but I'd prefer not to take it. I need to drive to appointments and things every day this week. What medication regime should I be on until things settle down? Many, many thanks.

 

[Slainte]

Falling right on your knee must have made your heart sink. So glad it seems no permanent damage was done. And your poor shoulder? No fair. Hope Josephine has good advice to make it feel better. Sounds like your weekend will be fun!

 

[SarahJane]

Wberry was asking questions about recovery from having his patella shaved. I replied that I couldn't help because they'd replaced my entire patella. I assumed it was totally gone because it didn't show up on the x-ray I was given. I may have been a little muddled when I talked to the OS after the surgery, but I thought I understood him to say that it was gone. I could be wrong, though. I was mostly concerned about how many ligaments I had left. And muddled.

Anyway, @Celle wrote this in response to my comment on Wberry's thread:

"@SarahJane - they don't usually remove the entire patella, because it's attached to some pretty large tendons. It would be a real major if they removed it, and no guarantee that the tendons would reattach successfully.
What they do is shave off the back (underside) of the patella and then attach that plastic button, which replaces the damaged cartilage you had there. So, in the end you have one layer of bone and one of plastic."

Celle, if this is the case, wouldn't the shaved patella show up on the x-rays? The one print out of an x-ray they gave me doesn't show anything where the patella should be.

I suppose I could ask the OS' PA, but -- frankly -- I'm a bit tired of medical appointments.

 

[Celle]

Anyway, @Celle wrote this in response to my comment on Wberry's thread:

"@SarahJane - they don't usually remove the entire patella, because it's attached to some pretty large tendons. It would be a real major if they removed it, and no guarantee that the tendons would reattach successfully.
What they do is shave off the back (underside) of the patella and then attach that plastic button, which replaces the damaged cartilage you had there. So, in the end you have one layer of bone and one of plastic."

Celle, if this is the case, wouldn't the shaved patella show up on the x-rays? The one print out of an x-ray they gave me doesn't show anything where the patella should be.

That's a very good question, @SarahJane. Thank you for bringing it back to your own thread.

I think the answer is that the patella is a very thin bone, except in one area. It will look even thinner when the cartilage has been shaved off the back of it. Since the patellar button fits snugly against it, I think the whole thing (patella plus button) would show up as one object in the X-Ray, unless a special side-view was taken.
I'm going to ask @Josephine to confirm that, or correct me if I'm wrong.

I found a couple of images in this article that might explain a bit more:
http://bonesmart.org/forum/threads/knee-replacement-surgery-types-and-suggested-videos.4473/

This shows the large tendons that are attached to the patella. You can see why removing the patella itself would be a problem. It can be done in special
circumstances, but it isn't done routinely.

This shows the patella button and the patella.

I hope I've explained well enough.

 

[SarahJane]

Thanks, @Celle. I am still puzzled about the x-ray bit, but I think you must be right. I certainly haven't had the degree of pain or difficulty walking one might expect if the large tendons were removed from bone and then reattached to plastic.

 

[Celle]

Certainly ask your surgeon at your next appointment. I'm lucky because my surgeon explains everything very well. He has my X-Rays up on his computer screen and he points to various things while he's explaining. If your surgeon has a busy schedule, he may not have time to do that, of course.

 

[Josephine]

It feels like I've got myself some bursitis going on in my left shoulder.

I would rather imagine you've bruised the shoulder. Bursitis doesn't develop because of a blow but because of irritation or long term stress.

How is the function of your arm?This chart gives the normal range - you'll have to click on it to get the full size - but tell me which you can and cannot do

if this is the case, wouldn't the shaved patella show up on the x-rays? The one print out of an x-ray they gave me doesn't show anything where the patella should be.

It really depends upon the quality of the xray which can sometimes be fuzzy or unclear so the patella, which is actually a very small, thin bone, can be lost in the resolution.

 

[suemegane]

I am post TKR day 8 had epidural block from UK . Have had to muddle my way with exercises that were given to me on day 1 was a little out of it so didn't take in them so Bonesmart has come in handy. I use 1 pillow on Base, cushion at end & another pillow on top. Cover with a tucked in towel to make block & use my son's Arsenal Scarf to put leg on & off. Not having any PT arranged just doing it myself. Can't bend my knee upwards whilst laying down. Not sure if this comes next when swelling goes down?? You will be fine @Sarah Jane elevate, ice & meds. So glad you have good friends around you

 

[SarahJane]

So very kind of you to reach out to reassure me, @suemegane. I admire your ingenuity. I, too, used a scarf to get my operated leg up on the pillow stack until the anesthesia, etc., wore off and my thigh muscles decided to come back from "vacation." Great minds think alike! Glad you found Bonesmart. It was a Godsend for me.

 

[SarahJane]

@Josephine, thanks for taking the time to send me the arm range of motion chart. I pretty much have full range of motion, although achieving the full extension in three of the poses is painful, and not doable for the fourth pose.

The first movement: discomfort starts at 2. pain at 3, but I'm able to reach 5.

The second movement: pain starts at 9, but I'm able to reach 10.

The third movement: pain starts at 12, but I'm able to reach 13.

The fourth movement: pain starts at 19, and I'm only able to reach 20.

More facts about me which might help you

There's no sign of external bruising. I'm 5'2", 190 lbs., type II diabetes, bilateral carpal tunnel (surgery to cut that little circle thingy the nerve goes through), a bit of cubital tunnel (no treatment). lots and lots and lots of life stress. I drive with my window down, and my elbow sticking out the window. But in my fairly new-to-me-used car, I have to lift my arm up a bit to get it out the window. So there's a little self-imposed postural strain there of which I am normally unaware. Today I spent a total of 45-60 minutes driving. It was hard to turn the steering wheel 90 degrees to back out of my parking space and head toward the exit of the garage. It got better as I went along, but now at the end of the day, there's a circle of soreness and discomfort which extends about 5 inches from the shoulder joint in all directions. Hope this helps. Thanks very much for taking the time for this.

 

[New England Librarian]

Hi @SarahJane - one reason I joined this forum instead of continuing to lurk was so that I could tell you how much I enjoy your posts and your sense of humor! Your experience with TKR and advice are excellent, too, but it's your attitude and spirit that really motivate me. Thank you and please keep posting!

 

[Slainte]

Just wanted to tell you I think it is no fair that you are having this pain. Hope you figure out a cure very soon!

 

[SarahJane]

:::: @New England Librarian Thanks, @Slainte.

off to go out into the world for the rest of the day. will let you all know how it goes. at least I'm not driving.

 

[Thesoutherncook]

Is tomorrow "our" Greek lunch? I'm so looking forward to it - vicariously! I bet it's going to be great fun and delicious food! Please tell us all about it!
I hope your shoulder is improving. Are you still icing and RESTING it???
Galoshes? Wellies? Rain boots? Seriously, in LA? I picture everyone in LA tottering around on 4" heels!
Of course, I've never been to CA - ever!

 

[Josephine]

But in my car, I have to lift my arm up a bit to get it out the window.

This actually tells me more than the ROM chart! It's entirely possible that you have damaged, strained or even torn the supraspinatous muscle as denoted here - somewhere under the bone between the two arrows or where the red star is

This muscle it responsible for part of the actions you describe as being a problem. It will heal in time but can take several weeks our even months. Here's some exercises to do (gently) at the rate of 4-5 reps about 1-2 times a day to keep the shoulder supple and prevent a frozen shoulder developing. For weights use a small 7oz can of beans

 

[Wanttobebiking]

So sorry to hear you hurt your shoulder in your fall. I agree with Slainte, NOT FAIR!

 

[SarahJane]

Thanks, @Josephine!!! You may be right about the muscle. Today I found it difficult to reach behind me to get my seat belt. I also had some tinges of pain when I was wheeling myself around an art museum this afternoon. As I type this, the pain/discomfort seems to be located about 2 inches down from the top of my shoulder. It's hurting a bit now because I was feeling that area to be able to tell you about the pain.

Since it may be a muscle issue, should I take any OTC pain relief, or should I just grin and bear it?

I'll do the exercises you provided -- again, many, many thanks! -- but do you realize the irony of doing exercises with a broom handle when the broom was the proximate cause of the injury???

Any suggestions on where to find an exercise band? I don't think I could get one through my HMO without going to my primary care provider to get a referral to physical or occupational therapy. And even then, I'm not sure about the HMO giving them out to people.

 

[Slainte]

That fall wasn't the frolic you had in mind, was it? Glad Josephine has come through with good advice. Enjoy your weekend!

 

[SarahJane]

@Thesoutherncook, the Greek restaurant has its own Wikipedia page! https://en.wikipedia.org/wiki/Papa_Cristo's

Today I was mindful of my body, did some active things -- including several blocks of hills! @Raffs, then went to the museum and promptly inquired about a wheelchair. Talked about shoulder in post #377 above. Knee was pretty good, considering, and I was considerate of it, which helped.

I brought along my new hiking poles and used them during the first part of the day. My friend and I were going to a luncheon, and then a tour of a small organic garden. We found a parking space halfway up the hill, and I used the hiking poles going up the hill. I'm glad I brought the poles. I'm not sure I could have made it up the fairly steep slope without them. My knee ached just a tiny little bit in the area right below the patella, but no more than a 2. The garden was very small, so getting around was no problem. I got a lift down the hill to where our car was parked, which was good because it was steep enough that I'd been planning to do a zig-zag descent, kinda like a series of hairpin curves, to reduce the stress on the knee.

When we got to the new art museum -- getting there involved a block-long walk uphill -- I got a wheelchair. We only saw half of the museum. Strictly contemporary art, with a very strong collection of California artists. It began to make me feel sad because my father, who died a while back, was really into 20th century art. I know he would have enjoyed it a lot. As for me, while I intellectually understood and appreciated the importance of what I saw, about 90 percent of it I would not want in my home.

Hopefully, I'll have a trouble-free day tomorrow.

Hope all of you are doing well.

 

[SarahJane]

Helen, about that elegant fashion statement ... I want to protect my suede boots from the hoped-for downpours that El Nino is supposed to bring.

I guess I must hang out with the wrong crowd. I haven't seen anybody I know, from college students to a woman in her nineties, in 4 inch heels. They sure do have a lot of them in stores. But is that because they are so popular shopkeepers want to keep a large selection in stock, or is that because no one in their right mind is buying them? Inquiring minds want to know.