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Author Topic: Post arthroscopy thigh pain...muscle spasm/sprain or possible DVT?  (Read 8341 times)

Offline Mtlcyclist

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Had day-clinic arthroscopy 4 days ago..elected for light general anesthesia. Small radial meniscus tear, some osteoarthritis cleanout, etc.
No initial complications other than the expected pain the first day...

I had a huge muscle spasm in my thigh the afternoon after the surgery once I was home..the extent of which was hard to determine with the amount of hydro morphone coursing through me (4 mg every 3 hours).

The day after surgery, almost no pain, so I stopped all analgesics.† I noted that my thigh was quite painful, about mid-thigh, and running a line up from the mid-point of the patella.† I figured initially that it might be muscle bruising from the tourniquet...or maybe from the muscle spasm.

Per instructions, I removed the dressing and washed, etc., then replaced the neoprene "brace" support during the daytime.

ROM increased gradually, getting up to 100 degrees by the 3rd day post-op.

However, the pain in the thigh increased over the last few days to the point where it hurts more than any residual soreness in the joint.† I have a very slight tingling in the toes on the operated leg, and very slightly cooler skin temps along the calf and the foot (by feel).† The pain is palpable over a range of 4 or 5 inches along the vertical line extending up from the knee. Bending the joint to gradually increase ROM gives the impression that it's one of the quadriceps that has been badly sprained, but I'm concerned that it may be a DVT.† The pain is bad, but not enough that I've even resorted to OTC acetaminophen, let alone go back on the Dilaudid.

Itís worse after the leg has been static for awhile, either bent at 90 degrees while sitting, or lying flat out in bed. The pain reduces in strength after the flareup due to a change of position.† Honestly, walking hurts more because of this than anything coming from the joint, which is only tender and a bit swollen at this point. Icing on the thigh seems to help a bit temporarily.

I'm due to see the surgeon in 24 hours, but in the meantime, I can't get through to anyone.† Should I be rushing off to an ER or am I safe to wait this out until I see him tomorrow?† Our ER's here in Montreal have pretty long wait times.

And if it *is* a suspected DVT, what kind of scariness should I be prepared for?

Trying not to worry in Montreal...

Hyperext ACL & meniscus tear skiing '80 - MRI, no surgery, PT only.
Swelling after >1km walking for years
Injury '04 = MRI finds meniscus tear
Arthro '05 clean meniscus & undetected class 3 OA, 50% ACL strip noted.
Swelling/some pain after >1 hr biking. 3 yrs post-op, still only up to 50-80km.

Offline ATsoccergirl

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Re: Post arthroscopy thigh pain...muscle spasm/sprain or possible DVT?
« Reply #1 on: February 15, 2005, 12:27:56 AM »
Another possibility would be an acute compartment syndrome.  I just had a case study come across my desk in which an 18 year old football player developed compartment syndrome in the quad from the tournaquet during surgery. 

Does the area feel hard or tight, how does it feel when you stretch the quad?

1999 LR, 2002 ACL/PLC recon, reversal of LR, 2004 ACL revision, 2006 Car accident torn PCL and small fractures resulting in bone chips in my knee.  Torn MCL 3 times.  Wicked screws under IT band and Pes Anserine.  June 2008-Hip Arthroscopy.

Offline Mtlcyclist

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Re: Post arthroscopy thigh pain...muscle spasm/sprain or possible DVT?
« Reply #2 on: February 15, 2005, 12:51:09 AM »
It just seems to feel like a pulling sensation when I stretch past 110 degrees (my current ROM) - like the middle section of the front of the thigh is a string separate from the rest. Prodding around locates a very sore spot dead center on the thigh, inline above the knee, about 6 inches from the top of the patella.† The left thigh is all tense, but not "hard" per se (the left was the operated knee).† I finally had to take some acetaminophen. Colour and temps seems to be almost the same on both legs, still have a very slight numbness/tingling in mostly the left big toe.

What's compartment syndrome? Part of the muscle gets bruised and tender? Where do they normally put the tournaquet on the thigh? That was my first thought...then I thought maybe the muscle spasm when I got home did it (which may have been related to the tournaquet?).†

A friend of mine who's had a DVT (unrelated to surgery) said that IHO it sounded more musclular than DVT, as his clot pain wasn't altered by position or pressure.† He also said that if it is a suspected clot, diagnosis is typically by CAT scan, and then treatment is IV heparin for a few days, followed by oral blood thinners for 6 months.† I guess I was freaking at the possiblity of an angiogram/plasty.†

I really hope it's muscular...with all the superbugs going around in the hospitals nowadays.

I'll call my OS first thing in the morning..either he'll tell me to rush to the ER or perhaps see him earlier in the day...

And not that I'm worried at all..but I have a tiny amount of prolapsed tissue from one of the incisions..as if a piece of the skin flipped inside out.  I guess they can just snip that off and suture if need be...

Hyperext ACL & meniscus tear skiing '80 - MRI, no surgery, PT only.
Swelling after >1km walking for years
Injury '04 = MRI finds meniscus tear
Arthro '05 clean meniscus & undetected class 3 OA, 50% ACL strip noted.
Swelling/some pain after >1 hr biking. 3 yrs post-op, still only up to 50-80km.

Offline Teresa_S

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Re: Post arthroscopy thigh pain...muscle spasm/sprain or possible DVT?
« Reply #3 on: February 15, 2005, 03:01:34 AM »
DVT is usually felt as a lump, may be warm to touch, and is easily detected by a doppler study. Requires a IV heparin or lovenox sub q  until coumadin level is therapeutic. DO NOT RUB it if you think it is a dvt. THere are also blood tests to help confirm, ask OS Teresa
On going instrumentation failure, chronic infection,
Arthroscopes Left 11 Right 2, MRSA, L TKR† ,† Revision, LR x5, Medial and lateral meniscus repair, Broken prosthesis
Osteochondral Fracture,untreated 6 mths. Revision new tkr 01-07 awaiting new hip and right knee
R TKR pending

Offline Mtlcyclist

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Re: Post arthroscopy thigh pain...muscle spasm/sprain or possible DVT?
« Reply #4 on: February 15, 2005, 05:12:39 AM »
Thanks for all the info so far. 

I noticed a very light irregular series of linear bruises running transversely across the thigh, right through the point that is most tender. There doesn't seem be any bump or warm spot. Of course I'm still calling my OS first thing in the morning, but I wonder more and more if it might be something along the lines of what ATsoccergirl suggested.

Anyway, OTC acetaminophen (2 x 500mg) reduced the pain to an acceptable level.

Hyperext ACL & meniscus tear skiing '80 - MRI, no surgery, PT only.
Swelling after >1km walking for years
Injury '04 = MRI finds meniscus tear
Arthro '05 clean meniscus & undetected class 3 OA, 50% ACL strip noted.
Swelling/some pain after >1 hr biking. 3 yrs post-op, still only up to 50-80km.

Offline Mtlcyclist

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Re: Post arthroscopy thigh pain...muscle spasm/sprain or possible DVT?
« Reply #5 on: February 15, 2005, 07:23:18 PM »
So I saw my OS...he competely ruled out a DVT (phew)...as far as he's concerned, it's a contusion of the quad caused by the leg being held hard against an immobilizing post, below the tournaquet.

He prescribed moist heat regularly and mild analgesics.

I'm very much relieved, but thanks to everyone who offered info/advice.

He cut off that small skin slap that had popped out of the bigger of the two incisions and sealed it for 48 hours...so that's done.

And the best news is I have almost no swelling now 5 days post-scope, so I won't be needing any formalized PT. 

The actual damage is a small radial tear on the lateral meniscus, some osteoarthritis on the inside end of the femur..brought to grade II, and 50% remaining fibers on the ACL.  So I'm fine for "inline" activities like walking, running, biking, nordic skiing, and swimming other than the breast stroke, but I'll be getting a full two-hinge brace for downhill skiing, mountain hiking, climbing, and field or raquet sports.

I guess the osteo wear 'n tear is perhaps the thing I'll have to monitor most in the future.

Thanks again!

Hyperext ACL & meniscus tear skiing '80 - MRI, no surgery, PT only.
Swelling after >1km walking for years
Injury '04 = MRI finds meniscus tear
Arthro '05 clean meniscus & undetected class 3 OA, 50% ACL strip noted.
Swelling/some pain after >1 hr biking. 3 yrs post-op, still only up to 50-80km.

 















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