Severe calf muscle spasm preventing walking

[Edoorley]

hi all, my hsband had a TKR eight days ago. The first few days of recovery were tough but seemed to go well. He was walking on Thurs and Fri in the hosp. However he wasn't told to elevate, in fact he was given no info leaving the hosp Sat. By Sat night the back of his calf was extremely tender and he was unable to flex the foot. We got no response over the weekend, went back to see the surgeon on Mon, He could not even push the foot into a flex position. It seems the muscle was so irritated by the collecting fluid that the muscle has spasmed. They checked for blood clots and Xrayed and that was all fine. We were sent home with anti inflamatories. Now Wed night, it is still in spasm and he is in a lot of pain. He is trying really hard to push the foot back, without much success. This is pretty scary as he cannot walk as he can't put the foot to the ground and engage the quads. He is using a CPM and is up to about 50, which is also not what it should be, we believe. He is also using an ice pack to reduce swelling and irritation. The leg is very bruised all the way from the ankle to the top of the thigh. Does anyone else have any experience like this? We are very worried now about his end result. He is forty five and had this done as he has had knee probs all his life and two previous surgeries in Eng and Ire several decades ago. We had fully trusted that the care this time round would be correct.

 

[Josephine]

Getting on top of this is going to be a long slow business, I'm afraid. Your husband needs to make sure he does the following things

1. Elevation - needs to be high and well supported (when he's not using the CPM) and for long periods of time, not just half an hour here and there.

2. Icing needs to be as much as you can get and covering all the bruised/swolen area. Some of the members here has invested in a special machine which they swear by. Hopefully one or two will chip in with the details!

3. Pain control needs to be adequate. It's no good him waiting until he can't stand that pain anymore before he takes a pill. I made this chart to show how pain and pain meds work

You can see here how leaving it too long will take the meds longer to work. Permitting too much pain will increase swelling - swelling is often a reaction to pain and then itself causes pain.

You say the surgeon 'sent you hom with anti-inflammatories'. Does this mean it's all the pain meds he has? Does he have anything else like Percocet or oxycodone? If not, he should have. A TKR is - as you are discovering - an extremely painful procedure and he'll need pain relief medication for at least six weeks although he may be able to tone down to something like Tyenol after that. Everyone has a different journey and you just have to play it by ear. If you have no meds then you should plague your doctor for some. Anti-inflammatories are NOT sufficient at this time though they can be taken in concert with other pain meds.

I hope it goes ok for you.



Incidentally, what is the 'eithne' tag you have put in the tag bar here?

 

[RickB]

Edoorley,

Not to scare you but what you discribed sounds like a hematoma. This is what I had after my LTRK. I was in the hospital and they ran all the test. They could know find anything for a week, so they took me back to surgery and open up the knee to let the blood drain out. Please have them took for this.

God Bless,
Rick

 

[Josephine]

I considered that, Rick. But she said the surgeon had seen him and he had been checked for thrombosis. I would have imagined he would check for that also.

What bothers me is the description of it being from thigh to ankle. Cannnot figure that one.

 

[Edoorley]

Hi Josephine, thank you for replying so promptly and for the information. We went back to the doc today, unfortunately his surgeon is out of town so we saw a colleague. His thought was that he has Reflex Sympathethic Distrophy and wants him to see an EMG next week to rule out nerve damage. On the positive side it does seem that there is use in the muscle and ligaments, the calf is not as tender as it was but is still very tender. We are a little frantic regarding all the time lost before he can get to real physio, also so you think h can push the knee bends on the CPM farther than the 50 he is at now? The bruising is clearing up but it is all the way from the upper thigh right down to the heel. We are using a Game Ready Ice machine and he has Vicodin to take every four to six hours. He is also taking Ibuprofen. There was some mention of antidrepressants/valium as a possible remedy?? We are trying massage of the calf muscle, he is doing a little walking with lifts in a shoe as he can't flex the foot flat on the ground. A big concern id the inability to use the quad and raise the leg fully extended. I am new to the fourum and thought a tag was a name, sorry about that. Many thanks for your help, it is wonderful to have somewhere to go with questions, Eithne Doorley.

 

[Josephine]

No worries, I edited the tag so you can see what it's for.

As for your husband's progress, it IS a shame he has had this setback (PT-wise, I mean) but it's really not worth pushing too hard until it's started to clear up. My sister had something very similar and it was a few weeks before she could do any serious PT but in the succeding two years and having had a second knee and now needing a THR, her knee functions just fine now.

So all in all, prioritize. This situation is by far the most important issue in hand at the moment. He should do what he has been doing on trhe CPM but not push it further just yet. Not until he gets some input from the OS and/or the EMG test. Antidepressants will work as a muscle relaxant and help the situation to subside so I would have them if the surgeon suggests it.

Overall, it seems as if it is resolving a bit but it will probably be a slow job.

Keep us posted.

 

[Edoorley]

Hi, just wanted to give you a followup. The EMG found no nerve or muscle damage, the conclusion was that a build up of edema had caused severe nerve irritation preventing the foot from flexing. The neurologist also noted that two weeks after surgery is way too soon for a diagnosis of RSD.
The surgeon acknowledged that he had been very worried and has never seen the reaction before. The Achilles was also extremely tight. A combination of physio, icing, and the CPM have pretty much solved the issue. The knee is at full extension but only 71 degree bend so there is a possibility of manipulation under anesthesia. However a month out he is getting around pretty well on one crutch and has taken some small steps without any support. The pain is way better but not completely gone. It aches a lot, particularly at night. Thank you again for the advice, Eithne Doorley

 

[Josephine]

Thanks for the update. I had been wondering. Pleased to know that things are settling and he is regaining his progress.

 

[Gretchendz]

The aching, especially at night, is very normal and will continue, but diminishes over time. As I'm sure they told you, all the bruising is normal too.

If he does end up needing a manipulation there are many threads here from folks who have had it and most seem to have good results.

Hang in there! It DOES get better.