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TKR Suggestions needed for “tight band” feeling

Jamie

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The symptoms you are mentioning can be associated with CRPS, but at 11 months it's probably a bit soon to put that label on what you're experiencing. All of the symptoms you mention are within the normal recovery, even at 11 months out from surgery. The fact that your symptoms are resolving is a very positive sign.

That said, I do think the recommendations for you are good. Gabapentin can work wonders in settling things down in your knee. That tight band feeling can persist for over a year to some degree and walking should help with it. Acupuncture and massage also can help.

You are wise not to consider anything at this point like nerve ablation or other similar treatments. Some people just have a bit longer recovery than others. No matter how slow the progress, as long as things are improving, it would be best to continue what you're doing and try to be patient with your knee.
 
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Stiff knee NC

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@Tykey: I posted yesterday about visiting a pain management doctor. You might find the info helpful!
 

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@Stiff knee NC: Thanks for your update! I always appreciate hearing from people who understand. This weekend it is 8 months since my TKR. When I went to the Pain Clinic last month, the doctor said that while I don't meet the full criteria for CRPS, she suspects that I am on the low end of the spectrum. Like you, I chose not to have the nerve ablation at this point. I am on 1200mg gabapentin (2 pills at night for sleep). I used to have the scar sensitivity, but I had started the desensitization process on my own (rubbing it with rougher and rougher fabrics) as well as doing scar massage to make sure there was no tethering underneath onto my muscles. I also found that Lidocaine and Capsasin patches helped with desensitizing the scar.

Unfortunately, two weeks ago a new physical therapist had me doing a simple balance exercise on a foam pad, and that resulted in a big setback and flare up of nerve pain and tissue inflammation. Pre-surgery, my knees would flare up with unstable surfaces, and it's now clear that this issue was not resolved with the surgery. In fact, it was likely soft tissue pain and not bone on bone that was the problem to start with. So frustrating because the surgeon did not discuss this as a possibility. This is going to be a very long haul: it will require finding the line between trying to strengthen the muscles that will take the pressure off my soft tissues at the joint that are now doing all the work, and not swelling them up.

wishing you all the best!
 
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Stiff knee NC

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Wondering what my next step should be. I’m on week 3 of gabapentin (taking 300 mg 3 x/day.) Not helping at all. Have had 3 acupuncture treatments...the scar looks less red but no change in tightness/pain. Walking two miles 3 x/week...can tolerate it fine w/no additional tightness/pain once done. The ONLY thing that enables me to have any kind of life is my compression sleeve, which I wear about 15 hours/day. I go to see my pain doctor’s PA next week, and my orthopedic doctor the week after for my 1 year post-op check up. My only other 2 options are nerve block and, if that works, nerve ablation. Given that I have noticed NO help from “nerve“ medication, I don’t think it’s a nerve issue. But no one can figure out WHAT is the cause. Should I talk to my doctor about scoping it to see what’s going on in there? Feeling very hopeless. Appreciate any thoughts/ideas/suggestions.
 

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I am at 5 months, with many soft tissue issues that are causing pain and stiffness... I also feel that although I had bone on bone that there were soft tissue issues that were not factored in before or after the surgery. I am now going to a physiatrist who did a sonogram of knee and surrounding tissue... I have fascia stuck all around my new knee... who knows why... maybe it was also stuck to my old knee... but this is not evaluated pre surgery...Anyway... I finished my first set of saline and lidocaine shots... will go back monthly for a while... am going privately for fascial release massage... plus deep tissue 2 times a week in PT... and myself doing it as well... I have to say it feels good when doing it... does hurt later in day... but I do feel slow improvement. I have this tightness and pain surrounding whole knee and up the IT band. Dr said it would not be overnight fix to break up the fascia (Saran wrap casing for all of our soft tissue)... but am hopeful .... may want to ask for a sonogram of soft tissue to see what’s up...
 
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Stiff knee NC

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@DBN: thanks for your response! I had a number of “therapeutic” (deep tissue) massages when I was 3-4 months out. Thought they helped somewhat. But they were very expensive ($135 + tip and are now, w/COVID precautions and extra cleaning, an extra $15...all not covered by insurance). No one’s mentioned a sonogram, so that’s something I can ask my orthopedist about. No one’s EVER talked about my fascia either. I’m assuming lidocaine injections are a “nerve block”? My doctor mentioned novocaine, which I’m guessing does the same thing. My pain specialist also recommended massages and walking. Please let me know what the saline shots are for. Would like to hear what a forum advisor/moderator has to say on all this. THANKS!
 

DBN

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The saline is to hydrate the fascia which is brittle and non pliable... hence causing the stiffness.. Think of it as Saran Wrap that is too tight....the lidocaine was just to numb the pain....All of the injections are done while she can view the fascia under a sonogram... I just did it once so far... go back in a few weeks.... can’t say it has solved any thing yet... just gets the fascia readied to be moved...

And yes the massages are out of pocket and expensive.... as well as every cream I have tried... can’t say any have worked...cbd.. arnica..t-cream, magnesium oil, voltaran... and last iontopheresis with dexamethesone....am at a loss...
Some days better than others.... morning better than evenings...

I keep hoping that time will continue to improve all of this...but??!
 

Celle

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I think DBN's treatment is somewhat unusual and it may not be appropriate for you, @Stiff knee NC .

I have to point out that stiffness at 5 months post-op is quite common and not abnormal. This is a recovery that takes a full year. All your soft tissues were pulled aside and manipulated during knee replacement and it does take a long time for them all to settle down again. All that is a normal part of recovery.

I know how tempting it is to want to "do something" to help, but really the best action is just to let Nature get on with the job of healing, without interference.

By the way, it;'s normal to have fascia around soft tissue such as muscles. it doesn't need breaking up. There may be a few areas where adhesions are sticking some small areas of fascia together, as illustrated in this article:
MUA (Manipulation under Anaesthetic) and Adhesions
 
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Stiff knee NC

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@Celle: I appreciate as always your response! Is there ANY value in getting a sonogram? My dr didn’t think so but I could get one elsewhere. I didn’t think any magic would happen at the one-year mark, but had hoped to be feeling lots better; last time I noticed any improvement was about 4 months ago. I feel that at a year out I’m way behind normal...and it’s really hard not to do something!
 

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When I experienced soreness in my quad area with my first knee (not the knee itself) the PT recommended a type of deep massage for so called "scar tissue." All that did was make it more sore. Ultimately it appeared to be a kind of tendonitis--probably from too strenuous PT. I cut way back on activity and slowly increased over many months. That was what led to improvement, not the manhandling.
You probably don't have that issue, but I do wonder if all the massage & other things are just keeping it aggravated.
 

DBN

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I do wonder that too... have tried not manhandling... resting more or less..stretching more or less... honestly at a loss... For me it is ‘only’ 5 months... but not one day without pain. I also think this may be tendonitis or tendonitis... not really clear on difference... Is tendonosis more chronic... If so, is time and rest the only path? And what happens when activity starts up after rest?
 

Celle

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@Celle: I appreciate as always your response! Is there ANY value in getting a sonogram? My dr didn’t think so but I could get one elsewhere.
I think I would trust your doctor on this. But if you feel that having a sonogram would reassure you, then you could ask again to have one done.

I didn’t think any magic would happen at the one-year mark, but had hoped to be feeling lots better; last time I noticed any improvement was about 4 months ago. I feel that at a year out I’m way behind normal...and it’s really hard not to do something!
I know it's hard not to do something, but you do need to be careful not to do anything that might aggravate your tightness.

No, of course an instant miracle isn't going to happen at the one-year mark, but I do know that some people have found their knees continue to improve long after that year.
 

judgar

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My left knee is 6 years old. I had the same problem with the right one I had done 11 months ago. The one that is 6 years old has gotten better as the time went on. It was tight . It is so much better now. So it will get better for you it might just take time but you got to believe it will get better.
 

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@DBN and @Stiff knee NC. I am 3 months shy of being 3 years out from surgery. The stiffness and constant pain was a problem for me as well. I have had a CT Scan and a bone scan and have been told by my surgeon and a revision surgeon that there is nothing wrong with the hardware in my right knee. I had been to 3 different physical therapist practices trying to get relief. In November last year, I was at my wit's end because the stiffness and pain was affecting my quality of life. I was referred to a therapist who specialized in problem knee recovery. Deep tissue massage working on my IT Band and ultrasound helped but did not eliminate the issues. Enter Covid and I have not gone to PT since February. What helped me was using KT Tape (I took it off before going to bed every day; some say you can leave it on for a couple days but I was not comfortable doing that) . I watched several videos on YouTube on KT Tape placement for IT Band syndrome, tendonitis and for kneecap instability as my kneecap had a "little wiggle room". I watched YouTube videos for exercises for IT Band syndrome and also watched videos for kneecap instability. I have focused the last 4.5 months on the the IT Band exercises and the kneecap instability exercises. I also use full spectrum CBD salve on my knees and I massage my IT Band using a handheld massage and push as hard as I can stand on the IT Band. I continue to use KT Tape. Unfortunately, I was not able to find a physical therapist who was able to place the KT Tape properly so I relied upon recommendations of others. I would try a certain placement and, if it didn't work, I would adjust it. I kept working with placing the tape in different locations over the last year and have found what works for me. I still have issues sitting too long but I can say that I am much better than I was. In addition, I now find that I do not need the KT Tape every day and only use it occasionally. The point of my post, don't give up. I thought I was going to have to live with constant pain. The last few months have shown me that this may not be the case.
 
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@4quilts: thanks for writing. I appreciate your feedback and suggestions. Back in November, when I was 3 months out, I went to a sport massage person and she did the “taping,” too. She recommended Rock Tape. For me, the compression sleeve worked better than taping so I only taped a few times. Sounds like you’ve got the placement all figured out, but I wanted to show you how she did it. Hope the photo uploads ok (not too tech savvy). Also hoping you are doing better!
 

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Stiff knee NC

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Last Sunday was my one-year mark...a milestone for sure. Had my check up yesterday with my surgeon. X-rays showed a bone cyst (the first I’d heard of it; I don’t know if it was there in November during my last x-ray). He quickly added that since the three-phase bone scan was normal, we didn’t need to do anything about it. (I do have my kneecap). Has ANYONE heard of this? Is it really something that can be ignored and, more importantly, could it be related to my ongoing tightness/pain?

The pain doctor recommended a compounded lotion (which I’m probably not going to get because not one lotion/cream has helped). Trying nerve medications Lyrica and Gabapentin didn’t help, so she prescribed Topiramate. This would be an off-label use of this drug. Thoughts?

My doctor said that there are no more tests he can order and that an orthroscopic look-see or revision are not warranted because, structurally, there is nothing wrong. We did discuss nerve block, again. At this point I’m going to see a doctor at a nearby, well-known university hospital.

And lastly, my doctor emphasized what many Bone Smart advisors have stressed: that healing can occur at least 6 months past the one-year mark. I’m doing everything I can (walking, massaging, etc) to ensure that happens.

As always, I appreciate any feedback!
 

Steelergal

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@Stiff knee NC I've been catching up on your story and the other comments and I'm SO relieved to know I'm not the only one with these issues! I just hit my year milestone and I'm still experiencing a lot of stiffness, lousy ROM and extension, nerve pain, etc. I've been told I could have CRPS (by my physical therapist), but not officially diagnosed and not medicated. My OS suggested I keep trying to desensitize the area (though that hasn't really worked). I know I can still gain ROM after a year, so I'm just doing exercises and walking a few miles a day. My next step is to look into acupuncture. Please keep sharing your progress and anything that's helping you! :)
 

Pumpkln

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At this point I’m going to see a doctor at a nearby, well-known university hospital.
This is probably your best option to help determine why you continue to have problems.
Be sure to bring your records, x rays before and after the bone cyst was diagnosed, bone scans, and any others tests or imaging.

I would want to know why you have "suddenly" developed a bone cyst, and what is the recommended treatment.
 
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Been on the new nerve medication and the new, compounded lotion for a little over a week...no change, but it may be too early to see any improvement.

Is there ANY possibility that I’m experiencing a reaction (or sensitivity) to the cement or implant’s metal? I have no known metal allergy, and I know it’s rare, but it might explain my persistent pain and lack of improvement. I haven’t noticed ANY change for the better in about 4-5 months....
 

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Hello Rockgirl4 Snd Stiff Knee NC

This Mamie and I am happy to be following you both. Pardon me for ease dropping but your concerns are partly my own too. I’m at 4 weeks post op and finding stiff knee issues every morning when first up. Both of you are way ahead of me and it both makes me nervous but happy about hope. My weight gain is 17 pounds and all fluid I can’t get rid of. They wrapped my left leg in a compression wrap and in several hours fluid began to leave and finally ten pounds were gone but moving around it came back. Finding compression wraps here is not easy.
BTW. I conference call my friends every Sunday in Poole. Is that close to you?

My range of motion is only 70 as of last Thursday and I think more now but the Swelling is too bad to go far. Your range of motions seem great to me and given me such hope that time even up to 2 or 3 years is possible to get more. My surgeon complains that it’s not 90 degrees and even wanted it at 7 days. The two of you are inspiring as the moderators are here. I wish you both all the best in healing. I’m happy to know that ice keeps helping into that time too. One of you spoke about a compression tube. Is it on Amazon?

I'm not sure about the time it is wherever you are. I thought Slurrey was in Canada. But I, never been good at geography. Lol.

Goodnight
Mamie
 

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