ACLr/Compartment Syndrome/AF/Peroneal Nerve compression

[kcknee]

Thanks. I couldn't believe it when I felt the pressure going up again. It hurts, but not with the intensity of pre-surgery at all. Today I was only asking for anti-inflammatories, last Fall I was begging and pleading him to filet my leg open.

I have muscle damage that did not show up on an EMG early last Fall, but by the time I got my MRI  late Fall, the peroneal muscles and the extensor digitorum showed signs of damage from the high pressure. After the surgery my OS had told me that 2 muscles were damaged but should mostly recover. I knew I had difficulty extending my toes (extensor digitorum)  and found out Saturday that I have even more trouble pointing my ankle/foot down and angling my foot out (peroneal muscles). My damaged muscles were not recovered enough yet to walk through the obstacle course of kids jackets and bags and are inflamed and swollen. It is this swelling/inflammation that I am trying to reduce. I'm not quite sure, and neither is my OS, how I am going to strengthen these muscles to help them recover without sending them into the inflammation/swelling cycle which will cause compartment syndrome in an already too tight leg. We're hoping high levels of anti-inflammatories will help.

Kristin

3/9 - Having a strange reaction maybe to the medicine. My left leg is way more swollen than it has been in a long time. My husband even noticed it on his own and he never notices anything. Not sure if there is some kind of infection that is fighting back against the antibiotic cream or something with the Lodine. Pain is about the same CS wise, but the incision with the holes is stinging more than usual. I never have any pain from the other incision. I went at lunch today and had blood taken for the Sports Doctors tests and called his office and gave him an update on how my appt. at NYU went. They'll call me when they get the test results back.
 

[Clarkey]

Hi Krsitin,

Sorry you ongoing knee saga is still going on and it seems to be one thing after another with your knee. Hope you get some answers to what causing you all the pain discomfort you are experiencing when you get the blood results back!

nickwclarke@BhamUK

[kcknee]

Thanks Nick.

The difference in the perception of how my leg is doing between the Sports Mediciine Doctor (SMD) and my OS would be comical if it wasn't about my leg.

The SMD has seen my leg for more compartment pressure tests than I want to count since he first tested the pressures in Fall 2010. He has worked with my NJ OS for years. He was horrified at the way my leg looks now and kept telling me throughout the appt. that I was in danger of losing my leg. He couldn't believe it was so swollen and oozing this long after surgery. He gave me the script for the blood tests which include specific tests to check if my muscles are infected/damaged. He thinks I should have a bone scan to rule out bone infection and an MRI to locate and see severity of hematomas and condition of my muscles. I think he had one other test that he wanted to run, but stopped in the process of frantically writing prescriptions and said he'd wait to see what the OS ordered before he ordered any major tests.

The next day, my OS gave me antibiotic cream for what he said was a topical infection. He hopes that extra anti inflammatory will help the muscles recover and stop the increased pressure. I'm on my own and have no follow-up or testing scheduled.

I'll see based on the blood test results what the SMD thinks should be done next. The SMD knows me completely differently than any of the OSs. When I saw him I never had to be strong or argue with him to be believed on what was happening in my leg. He got to see me scared and desperate and struggling to figure things out. I hope if he is now becoming my "doctor" that the relationship doesn't change and I can still count on him to listen to me and believe me.

Kristin

[Snowy]

That sounds like a pretty scary appointment. It sounds like you've got some pretty strong support from the SMD - and at this point, after all the complications and everything you've been through, it makes sense to play everything as safe as possible and have every test that you can. Did you mention your SMD's concerns to the OS? How long are you going to give it with the topical infection and anti-inflammatory before you go back to see him again, or will you just try and proceed with the SMD if things don't improve?

I'm so sorry that things aren't going so well right now, but I hope they're right and it is an infection that can be easily cleared up. Keeping my fingers very tightly crossed, and as always sending good thoughts your way. You really deserve to cut at least one break on this, after everything that's happened.

[Lottiefox]

Oh my Kristin, I hadn't realised things had got difficult for you again. I seem to have been behind with following the progress here as after the good vacation I had hope that the leg was on the up. As Snowy said, that does sound like a difficult appointment but it also sounds like the SMD is taking the issues seriously and I wouldn't think he is going to leave you all on your own with this. As Snowy said, what is the timeframe with this? I am so sorry you've got to have yet more tests and that things have not settled down. Goodness knows after all of this you really deserve a break with it. It must seem like a waking nightmare some days. I am sending MUCH love and positive thoughts for this to gain some form of resolution.

Please keep us posted, I shall be following carefully for any news. All fingers and paws and non fused toes are crossed here too that it is an infection of some kind (that sounds wrong, but you know what I mean.)

Lottie xxx

[emergRN]

Hi Kristin!

I am so sorry that you are continuing to have problems, but it sounds like you are being listened to.  All I can say is that I hope things improve soon.  Thinking about ya!

W

[kcknee]

All my blood work came back within normal limits!!! I still have the non-closing infected incision holes, cs pressures in my muscle compartments and too many hematomas, but I don't have a scary bone or muscle infection. Nothing like a possible worse crisis to make what you're dealing with seem not so bad.

I'm so glad that the SMD was being too paranoid. Now I try to relax and get back to dealing with the medical conditions I thought I had to begin with. So far I am not noticing much difference from any of the medicines. The holes are still stinging and oozing every day and my leg is still too tight. I think I only have a one month supply of Lodine from the SMD so if there is still no change at that point I'll make another appointment to see him. If the hematomas are still as bad, I'll ask him about the MRI test he talked about.

Thanks everyone for the support. Thankfully it was a false alarm and everything is okay.

Kristin

[Snowy]

So relieved to hear this! I have to admit that I was panicking on your behalf when I read your report from the SMD. Definitely better to play it safe given everything that's happened, but I'm so very glad that you're not looking at a deep infection in the muscle and bone. I'm also glad that your OS was on the mark with the diagnosis - I do wish that he was being a bit more proactive about followup given what you've been through, but it's great that he was right about this not being a new crisis.

Fingers crossed that the tightness and oozing start to subside soon. Is it possible that the tightness inside the leg is contributing to the wounds not closing fully?

Keeping the good thoughts coming - hopefully the meds are just taking time to take effect.

[tez27]

Kirstin sorry I haven't posted for a while, but I have been keeping up with your diary and I'm so pleased your tests have come back ok, after everything you've been through so far it must be a relief, I'm also so pleased you seem to have found a Dr who cares and listens to you, after you having to fight to get your OS to take all your symptoms seriously and do something about them. I think in your case a paranoid SMD is exactly what you need after everything that has happened.
Take care Tez   

[kcknee]

I believe that most of my problems right now are because my leg is too tight.

Before the surgery, the OSs had discussed leaving the incisions open and using skin grafts but then decided to close. I was hoping I would somehow get lucky, but the surgical hematomas/seromas in addition to the muscle hypertrophy is just too much in an already tight leg. I told my OS from the beginning  that the incisions weren't closing because the hematoma below it kept the skin too tight and too far apart. The holes are right were the blood blisters were so the skin there is thin and isn't in the best shape anyway. The infection is because I have had open holes for going on 3 months. Thankfully it is not deep.

When my injured muscles were overworked recently they swelled and became inflamed (normal reaction and necessary if I want to try to work them to get them to heal) but my leg is too full and tight and can not handle the increased swelling and that's why the compartment syndrome started happening again. I'm now trying to get the mega-dose of anti-inflammatory drugs to hold the muscle swelling down so I can try to strengthen and heal the muscles without causing CS. Besides reopening the leg or surgically removing the hematomas, I'm at a loss of what else to do. I'm hoping the hematomas will get smaller in time as they reabsorb. I haven't been able to find much research.The OS and SMD are pretty much just following my lead and prescribing me what I ask for, at this point, they don't know either. 

I had to stop wrapping my leg to not add to the increased pressure due to the muscle swelling and now the ankle hematomas are again pressing on the nerves and blood vessels going to my foot and my foot is tingling and going numb.  If I can get the hematomas to go away, I will have that additional space again in my leg and the added benefit of looser skin that has been stretched to accommodate the hematoma masses.

3/14-Still no changes in the leg or the holes, but leg is much more swollen. PT wouldn't let me do much tonight. Sorry for venting above. It's just frustrating to get so close to feeling better and then to slide back down again. Hopefully the muscle swelling starts to go down soon so the pressure in my leg will drop.
3/19-Fun weekend with family in Boston for St. Patrick's Day. Finally started to feel the Lodine working on Friday. Still very swollen and tight, but pain has decreased. Incision holes still open but smaller; much hotter as well as front of leg. At PT today he said the pain and tightness in the back of calf is most likely a trigger point. PT said to stay on full dosage of Lodine for a few more weeks and no walking for at least a week. 
3/20 SMD gave me by phone a Lodine prescription for 250mg pills twice a day. He agreed with me I should try to cut back dose and see how muscles react. PT and I wondering if maybe I have an infection in encapsulated seroma/hematome below holes keeping incision holes open and leaking. If encapsulated, infection would not show in blood. Not sure what to do even if this is right besides hope it doesn't burst.

[ouch09]

What is the expected time for the incision holes to heal ? I would expect that you can't leave them open for ever ?

[Snowy]

Hey Kristin,

Just to let you know that I'm thinking about you and keeping my fingers crossed that you're starting to see a reduction in the pressure and tightness in your leg. Glad to hear that you were able to enjoy St. Patrick's Day in Boston. Are you back on crutches at the moment?

Would an infection inside the seroma heal by itself, or would you need antibiotics?

Hoping that you've seen some positive progress this week.

[kcknee]

I actually wrote to the PA of my OS yesterday to fill them in on how my muscles were doing, the change in medication dose, the clean blood work and to find out that same question. "What is the expected time for the incision holes to heal ?"

I was told "He is not worried about the hematoma/seroma and in his experience this can take a long time to heal.  he would like you to keep using the Silvadene cream and keep us posted. "

The muscles are doing a lot better and I did most of the usual PT exercises tonight. Once I'm sure that the inflammation is settled for now I can start walking more and on unlevel ground to try to strengthen the muscles and then hopefully if no reaction progress to stepping over small hurdles at PT. My PT thinks that the muscle swelling - CS reactions will happen on and off for the next year. What fun, but at least next time it won't be so unexpected and I will know to start taking the anti-inflammatories and it will calm down. The OS is still trying to get the patches approved.  I never went back on crutches. I wasn't sure if it would help and life is so much easier without using them. I didn't ask about the encapsulated seroma infection theory. I think my OS thinks I'm annoying enough asking medical questions last Fall, it's just that I was kind of forced to try to diagnose myself for years so it's hard to stop.

My husband started going off last night that the incision holes looked like they weren't leaking.  I made him put his finger against one so he could see his finger was then wet. He's worse than any OS at not believing me and needing proof all the time. 

Kristin

[Snowy]

This all sounds like good news (except for the sceptical husband, but hopefully he got the message.) Fingers crossed that the inflammation continues to settle, and you can keep progressing the PT.

It's just as well you started trying to diagnose yourself - given the runaround that you got from the medical system, you really needed to be your own advocate. It's crazy how much knowledge we end up acquiring through these experiences...

[kcknee]

I started trying a non-prescription anti-inflammatory cream on my leg on Friday. The cream promised to cure inflammation in joints,muscles, tendons, ligaments and nerves and treat numerous conditions so I was not expecting it to actually do much. I figured I could use this until l get the patches from my OS. Today at work my leg especially below the incision holes and up the side of the medial incision  was stinging a lot - not sure if is because I cut the Lodine dose in half starting on Friday or because I didn't put on that cream this morning. I went home at lunch and the cream actually does seem to calm the stinging pain a bit, not sure if real or placebo effect, but I will take either.

Unfortunately,  I stepped in something nasty that one of the dogs had dragged in the house while I was home. I went outside to scrape my shoe to clean it off and realized too late that the motion that is used to scrape one's shoe off is the same one that started the problems a few weeks ago. So I'm back in the office now with a clean shoe, but am feeling a sharp pain and tightness increase in my peroneal muscles and am hoping that the swelling doesn't get too bad this time.

Kristin

-My leg is definitely tightening, I have the too tight cast feeling around my upper calf and lots of tingling - just got back from PT. My PT was laughing at my dumb luck. I have some 3yr old full dose pills of Lodine I will start taking tonight to try to get this down. Unless my OS reads it here, he is not hearing that true way I injured my leg again. Hopefully the swelling will stop and he never has to know.
3/27- Lodine is keeping pain down except when driving when foot is flexed up, but I am limping when walking as foot is not lifting up easily.