The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: kscope09 on November 14, 2010, 10:43:15 PM

Title: Tenderness on the inner shin
Post by: kscope09 on November 14, 2010, 10:43:15 PM
This week my my right shin on the insie, just below the knee has been getting really tender to the touch.  It doesn't stop me walking, but I can feel it wehn standing and sitting and sometimes when laying down.  I don't know what has brought it on.  It is blow the knee and on the inside and seems to go down in a line about 3 inches long.  I havn't been doing any sports so it can't be shin splints or a stress fracture but I do have a nasty feeling it is refered pain from my chrondoplasty failing.  Teh defect was on the non-weightbearing part of the mfc and I've had this feeling pre surgery, about six months after I first injured my knee.  Then it went away for ages and ahs come back this week.

I'd like to know from others who've had similar chondral injuries.  Did any of you have pains like these or were they localised in the knee joint itself.  The knee joint hasn't been too painful lately so there's still hope for the chrondoplasty?  Would I need to go to see a doctor about this or do you think a couple of days of rice will help?  I've decided to cut down on my squatts for a little while to see if that amkes a difference.
Title: Re: Tenderness on the inner shin
Post by: cdubb on November 15, 2010, 01:05:44 AM
I currently have a lot of pain in my entire shin down to my foot/ankle; however, I also just had a ACI/AMZ (TTO) 11 days ago  ;)

Prior to surgery; however, I did (and do on my other leg) have pain that goes down my shin and it was about 3 inches like you describe. When I mentioned that particular pain at one point to my OS, he didn't particularly pay too much attention to it, as I also had other anterior knee pan and at times significant swelling.   My chondral defects are on the back of my kneecaps, grade 4 versus the MFC defect location that you have.  If you had a chondroplasty, not really surprised it would fail because all they are doing is debriding the defect.  They generally only provide short term (if any) relief.   You can try good ol' RICE and some anti-inflammatories, but if it doesn't work, a trip to the ortho may be warranted.  Depending on the specifics of your defect, there are other possible options like ACI, OATS, microfracture, etc. I personally wasn't a microfracture candidate due to location, but I was an ACI candidate if done in conjunction w/ AMZ.
Title: Re: Tenderness on the inner shin
Post by: kscope09 on November 15, 2010, 10:49:56 AM
I've been told that chrondoplasty should last 10 years and if it ahs failed which I've been constantly on pins about for nearly a year and a half then I would hope that I'm at least a candidatefor microfracture.

Are microfractures less vulnerable to failure than chrondoplasties.  The post op instructions are about the same and I had chrondopalsty because the defect was verys mall, too small to show up on mri.
Title: Re: Tenderness on the inner shin
Post by: Vickster on November 15, 2010, 01:31:25 PM
How large is the defect and what grade is it - is it through to the bone?  It seems strange to have so much discomfort if it is on a NWB surface.  I would avoid squats if at all possible as they place loads of pressure on the knee (I cannot do them, hurt like hell, but then I have a patella defect (which was shaved, so a bit like chondroplasty I think) as well as the one on the WB lateral condyle).  Also, make sure that you ice after all exercise.  Knee pain is weird, all of my issues are laterally but I have medial swelling and tenderness as well

Microfracture seems pretty hit and miss - also, only produces fibrocartilage which can remain problematic - as mine is following the injury to the cartilage (~1.5cm2 defect filled in of its own accord but has never settled, I guess because every step I take places pressure on it).  Something like moasicplasty might be an option - my OS believes it is best suited to small 'punched out' defects but as yours in NWB anyhow do you want more cartilage damage to a further NWB surface? 
Muscle strengthening should be your first port of call I reckon - get on that static bike :)
Title: Re: Tenderness on the inner shin
Post by: kscope09 on November 15, 2010, 02:42:06 PM
It was full thickness but narrow enough not to show up on mri.  I think the reason the surgeon didn't do mfx was because he wouldn't have been able to get more than one hole drilled.  There is no swelling and the knee is nice and cool.  All the pain is below the joint and when I touch the area it just feel slike a bruise, as if I've been kicked there but I havn't.  I have had a busy week alst week and I've been wearing some different shoes that I don't normally wear.  When I saw the pt that just wanted to get rid of me she had me doing single leg dips which I would normally avoid like the plague, so I wonder if they have just aggrivated things and maybe a bit of RiCE will help it settle down.  Ice does seem to relieve some of the tenderness.  Strangely though it feels worse when sitting that when standing or walking.  I'm resting today and if it doesn't seem to be improving then I'm off to the doctor.  I'm sti.ll hoping it isn't the chrondoplasty because I had this pain pre op and got rid of it ages before the op.  Back then though the pain was higher up and around the hinge-like part of the side of the knee.  The location oft he shin pain is more on the bony inner part of the tibia and I seem to be able to walk OK but it does irritate it a bit.  I was once warned aobut shin splints before by a pt but as far as I know they tend to be lower down.  IOf I'm going to need physio then I'll have to get a new one because the woman I saw alst week on the NHS was just looking for an excuse to get rid of me and has discharged me, right before the shin pain started.
Title: Re: Tenderness on the inner shin
Post by: cdubb on November 15, 2010, 02:44:09 PM
The specifics of your defect may or may not play into how long a chondroplasty may last.  My left knee, which is the just ACI/AMZ 'd knee, had a chondroplasty 7 years ago.  I had no defect at that time and just some typical chondromalacia that was debrided.  Now, 7 years later, I have a grade 4 - 20 x 20 defect (about half my patella), so a lot can happen in a fairly short time considering the lifetime our knees should last.  My right knee had a chondroplasty 9 years ago and I had that scoped same day as my ACI/AMZ and that defect was estimated 14 x 14 (however, at my biopsy scope my left was 15 x 15, so when they debride all damaged tissue, defects are generally larger than chondroplasty scopes.  

Even though in theory a patella defect is a NWB surface, I occasionally would get sharp pains under the kneecap while just walking.  Typically, they were on stairs, ramps, rising from seating, etc. but while not completley logical, just walking wourd hurt.  Doing quad sets would even cause the sharp pains.

Agree that microfracture is hit and miss.  One study I read comparing microfracture vs. ACI showed similar results at 2 years out; however, by 5 years out, almost all microfractures had failed and gone onto other procedures such as ACI and OATS and there are some other newer options such as DeNovo.  Your options would best be discussed with a cartilage restoration specialist.  

Agree though to get on with strengthening...and squats are terrible...maybe partial wall squats w/ a ball are okay, but not the kind I believe you are referencing with a bar on your shoulders.

Title: Re: Tenderness on the inner shin
Post by: kscope09 on November 15, 2010, 03:37:37 PM
I've never done squatts with a barbell.  i wouldn't dare.  When I do squatts I go down as slow as I can until I come to 90 degrees.  Sometimes I hold onto something but usually now I do it with my hands forward for balence.  I never go further than 90 degrees and tend not to get many pains while doing the squatt itself, just a little discomfort afterwards that subsides.  To get to 90 degrees I can do it so slow that it takes me a minute and these exercises are tedious and boring but I do 30 a day or 20 if I'm busy.

Pre surgery I could walk for the most par t quite well, thoug slopes and stairs were getting harder and harder and the knee would catch terribly and I had dull aches under the kneecap.  I did have pain when walking which was like a shooting pain when my heel struck the ground, but not all the time.  Non-weightbearing defects can still cause pain because of the shock when the foot lands as afterall the knee is still a weightbearing joint so it makes perfect sense to me that it should hurt when walking.  I don't have nearly as much walking pain as I used to.  Alos, the pts have kept telling me that my chrondoplasty would ahve developed fibrocartliage, though I'm not quite sure how and that if it was OK at 15 weeks (when I had my mri to check everything was OK) then it can't just fail all of a sudden for no reason.  I could wear out, but only if I'd been doing a lot of sport or running or carrything a lot of weight.  My pt did seem to think that pain from the defect would be localised, prior to surgery I had pain in every part of the knee at one time or another so it is hard to compare it with pre op syumptoms, but the shin pain is not the same.

What aobut shin splints? has anyone here had shin splints that high up?
Title: Re: Tenderness on the inner shin
Post by: mollyc on November 15, 2010, 04:47:11 PM
Look into per anserine tendonitis.  I had it and had pain in the location you describe.  That's the spot where several tendons and muscles insert into your shin bone.  In my case, it was related to an excessively tight hamstring on that leg and a super tight hip on the other leg that was causing excessive strain on those tendons when I walked, ran or did other weight-bearing exercise, resulting in per anserine tendonitis.
Title: Re: Tenderness on the inner shin
Post by: kscope09 on November 15, 2010, 04:51:42 PM
Thanks!  That's better than chondral problems.  How did you deal with it?  RICE and hmstring stretches?  I've been religious with quad and calf work and do tend to neglect the hmstrings and glutes, though I do do them I've never given them as much attention.
Title: Re: Tenderness on the inner shin
Post by: mollyc on November 15, 2010, 06:45:31 PM
I worked with a PT, who did ART (active release techniques). ART is similar to deep tissue massage, but is done while moving the limb. It breaks up scar tissue and eases chronically tight muscles. I also did RICE (especially avoiding any activity that aggravated it, like running, jumping, squats, etc), anti-inflammatories, and tons and tons of stretching. Eased back into full use gradually.  I think it took me about 6 weeks to heal it, but I keep up the stretches to this day because when I start getting tight again, I start feeling twinges in the same place.
Title: Re: Tenderness on the inner shin
Post by: kscope09 on November 16, 2010, 10:37:11 AM
It isn't any better today.  It feels like it is burning a bit and when I put on some ibugel last night I got the same sort of stinging you get when you dissinfect a cut.  I can't find any warmth or swelling but there is a sensation of heat.  Does this sound like per anserine tendonitis?

I'm seeinga  doctor ASAP.
Title: Re: Tenderness on the inner shin
Post by: mollyc on November 17, 2010, 05:06:15 AM
Hmmm. No, I didn't have any burning feeling. Mine was tender to touch, throbbed sometimes even when I wasn't putting weight on it, and hurt when I did any impact activities (running, jumping, squats, etc.) There was a clear relationship between activity and discomfort, although it took quite a lot of rest before it started to feel better.

Hope you get some answers from the doc. It's always hardest when you don't know what's going on...
Title: Re: Tenderness on the inner shin
Post by: kscope09 on November 22, 2010, 01:57:27 PM
It's been a strange week.  A week ago my shin hurt like the devil and was really sore but the skin felt a little rough, though it wasn't rd at all.  The burning I mentioned was when I but ibugel on it and it made it feel like when you dissenfet a cut, except the feeling wasn't going away.

I saw a gp on Wdnesday who did not thing that my shin problem was anything to do with my knee and gave me so cream for the irritated skin.  In a couple of days the bruisy, painful feeling in the shin subsided but the skin felt a little waxy and there was some little red dots.  I'm still using the cream and the dots are going and the waxy skin is not just where I've been puttin gthe cream but goes up on the inside of the knee, as high as the jointline.  On Saturday and Sunday I was not having shin trouble any more but I has having pains when I woul turn or slow down or stop walking, it made me think chrondoplasty failure instandlty.  Also, the kneecap moves about more when I move the leg back and forth and seems to dip down a bit when the leg is extended, should it do that?  Alos, where the skin was getting waxy, further up the side of the knee I put some creama nd it ahs lessenned the pain when turning and stopping, but it is still there.

About7 years ago I had shingles and I'm wonering if the pain is post herpetic neuralgia.  Any thoughts?
Title: Re: Tenderness on the inner shin
Post by: Vickster on November 22, 2010, 02:03:55 PM
Did you have shingles on your leg, if so could be PHN?  I had singles too on my back and I get a burning sensation from time to time - asked the GP once, but reckoned it was just dry skin - comes and goes, so have never bothered too much about it - it is however, horribly difficult to moisturise your own back lol.  My understanding is that you will only get PHN where you had te shingles rash as it damages the nerves, hence the pain.  My pain isn't bruisy, more burny like sunburn under the skin, not a definite spot that hurts when pressed like a bruise, deeper than that
The skin on my legs (ok I am a woman and do shave) get horribly dry and burny in the winter due to the cold and also central heating.  I know blokes aren't keen on moisturising but this could well be your problem so stick with the cream
Title: Re: Tenderness on the inner shin
Post by: kscope09 on November 22, 2010, 02:15:58 PM
The cream is working and it got the rash down.  Tne really weird thing is that the day before I went to the dr I couldn't see any redness at all and Icouldn't in the morning either but when I got there there was some redness.

I had singles 7 eyars ago and it went town from my back around my right leg and forked with one rash going into the groin and another going down the side of the thigh but it never went near the knee, so I guess it proably isn't PHN.
Title: Re: Tenderness on the inner shin
Post by: Lottiefox on November 22, 2010, 02:26:10 PM
Can you get gout in your knee?  :P
Title: Re: Tenderness on the inner shin
Post by: kscope09 on November 22, 2010, 03:04:15 PM
You can get gout in the knee but what is the cahnce of that happenning?
Title: Re: Tenderness on the inner shin
Post by: kscope09 on November 22, 2010, 03:10:59 PM
Actually gout is apossibility.  Can you get rid of it or control it is it doesn't bother you?  I've known people with gout in the foot and they usually get better.