The REHAB DEPARTMENT => Soft Tissue Healing Problems - General => Topic started by: Hiker girl on June 08, 2014, 04:27:07 AM

Title: Any treatments that work for femoral nerve damage?
Post by: Hiker girl on June 08, 2014, 04:27:07 AM
I am 2 yrs post op on right knee for fat pad trim.  Fast forward, I have never been able to walk well, balance, have terrible pain and go back and forth with my ability to straighten my leg.  Been rejected 3 times for PT due to lack of progress.  I now have a handicapped plate for my car.  This is flipping unbelievable.
I am on my 4th surgeon.  Last week I had a nerve conduction study.  The needles with the electrical impulses were...oh my! 

Oh and the surgeon who did the surgery won't release the surgical notes.

The neurologist diagnosed me with femoral nerve damage.  So back to the MRI machine I go. 

Is there treatment for this?  If so what is it? 

I really need solutions! 

Thanks in advance.

Title: Re: Any treatments that work for femoral nerve damage?
Post by: cahiker on August 23, 2014, 02:09:12 AM

I empathize with you as I am in a similar situation and am looking for info, too.  Four months ago I had a partial medial meniscectomy and patellar chondroplasty (which I was not told prior to the surgery was an entire procedure in itself - I was told by the surgeon that he would, "smooth out the cracking" in my knee, "while he was in there.").  I have been in worse pain and have had quad shut down ever since.

It started the day of surgery.  I was getting out of the wheelchair to transfer to the car after surgery, and my leg completely collapsed under me - it had never collapsed before.  My quads had completely shut down and I couldn't support my own weight.  The OS has been totally unapologetic, completely unhelpful, said it could be permanent, and said, "don't fixate on it".  Really??

I have learned that if anesthetic is injected into the knee during the procedure (usually marcaine), this turns off the pain receptors in the joint, and you don't get the shut down response.  The OS did not do this for me.  Did yours?  I see you said your orig surgeon will not release the surgery notes.  Has your neuro requested them?  If so, and the OS refuses, I'm sure there is a recourse - I believe it is illegal to deny you access to your records.

My glutes are not activating either.  My calves and hamstrings are doing the majority of the work (although the hamstrings are weak, too).  My un-operated leg is working overtime.  Lots of compensating going on; which causes its own problems.

I have been to 3 pt's and will continue exploring other avenues to improve my situation. 

What did your neuro tests show?  I think that will be my next step.  I want to know the condition of the nerves and muscles - maybe that will help with how to proceed.  I also wonder if the tourniquet was too tight, causing a crush or stretch injury to the nerve.  I want to know if it's a physical injury or a CNS issue - or a combination.  Did your tests show physical nerve damage?

The immediate shut down is definitely a nerve issue and not a disuse issue.

I also still have the original meniscus pain I went into surgery to have fixed, and I have additional new sharp, raw, aching pains in the kneecap (which was never painful prior to the surgery - made a little noise, but no pain).  I also have burning pain along the medial and posterior sides of the leg/knee.  I told my original OS that just days after the surgery and at every follow up appt and he kept denying it was nerve pain.  Even though early on it was accompanied by numbness, tingling, electric sensations, etc. and of course, the muscle inactivity.  So in addition to the muscles not working, the pain causes problems with exercising, doing stairs without pain, and strengthening, and could be perpetuating a shut down reflex.  Sounds like you have both pain and muscle shut down as well.  What type and where is your pain?

I have found NMES (electric contraction) helps with the muscles contracting - although I haven't had any real building of the muscles, and there isn't much "automatic" activation during movements.of everyday life.  But I want to continue it, and want to get a home unit.  Looking at my wasted leg is extremely depressing and concerning.  I was a very active person, and now anything beyond walking seems a fantasy. 

Unfortunately I don't think there is much to do to fix nerve damage - they can sew a nerve back together, or ease an entrapment, but the rest... not much.  And if it's a shut down reflex, no one has found a sure fire way (sorry for the pun) to switch things back on.

I found the taping the last pt guy did helped my kneecap pain a bit; has that ever helped you?

I try to stretch the muscles frequently, as I have learned that the muscles work in pairs, and that if the corresponding muscles (ie. the hamstrings), are tight, then the paired muscle (the quads) will be inhibited. 

A trainer I saw recommended power plate work.  It's a whole body vibration plate that you do movements on.  It's supposed to help with muscle and nerve response.  Worth a try maybe.

I can ride a bike a little.  Can you?  I do just short rides around the block - the stationary bike depressed me.  Moving through the world at a faster than slow walking pace is good.  It increases some of the pain, but the leg needs to be moved.

Yes, it completely sucks to be in the 1%.  I'm living it too.  You sound like you're young like I am (well, mid life), and a hiker.  This failed surgery has ruined my active life.  I feel for you.  I was hiking 10 mile, lots of elevation change hikes just a few months before surgery, now grocery shopping is painful.  It's been devastating, and the constant pain, exhausting.

I am interested in your story - hopefully we can help each other.  Hopefully others will respond with ideas.  I try to stay positive, it isn't easy, but despair sucks, so I just have to keep looking for something that will help improve things. 


Title: Re: Any treatments that work for femoral nerve damage?
Post by: Hiker girl on August 23, 2014, 03:02:03 AM
Hi Cahilker,

I am so sorry you are experiencing the same thing.  Sounds like my journey post surgery.  It is frustrating to be in worse shape than before surgery.  Keep with the stretching.  I am doing swimming, stationary bike which I agree is very depressing.

I went through MRI's on lower back, hip and thigh after the nerve conduction and EMG study.  The nerves are not impinged like they thought.  I am being referred to Neurology which insurance agreed to immediately.  However, it has to go through a committee in the Neurology dept so see if I will be taken on as a client.  Who knew about this roadblock?

I allow myself to have 1 or 2 days a month for self pity.  Just a great cry usually helps and then I move on....ha!  I am most upset by having to redefine who I am, what I can do and what I will probably never do.  I am finding that I am experiencing a lot of burning pain behind the knee and the surgeon says the remaining quads that are not affected are in a constant state of contraction to "wake up" the medial muscle I think it is called the VMO. 

I keep thinking well since there is nothing wrong mechanically I can force the nerve to wake up by working it more.  That is not a great idea.  So much pain, stiffness and swelling, so balance is the key.

One thing I did learn is by 2 yrs there is very little hope.  I don't nor will I believe that not for a minute.  I tell my leg each morning and night that in every way I am getting stronger and stronger.  My leg will begin working properly as it know how to do and that someway, somehow I will be well again.

BTW I am getting a very cool looking cane so that if my leg goes out I won't hurt myself.  I will be the female version of "House" :)

I am 2 yrs past where you are now so as I find more info I will pass it onto you.  Do the same for me yes?
Press your dr to do nerve conduction and is not fun but do it.  Information is important and if they find you flunk that things will move faster.

All the best,

I did have an anesthesia shot which I am sensitive to.
Title: Re: Any treatments that work for femoral nerve damage?
Post by: cahiker on August 25, 2014, 06:39:16 AM
Hi Debbie,

I agree, it's the redefining of who you are and what you can't do that is the worst.  Well, the worst is that we ended up in worse condition than we were when we went to the medical "professional" for help.  The consequences we are suffering are way out of proportion to the "15 minute simple surgery" we were told to expect.

What were the results of the nerve tests?  Did they show actual reduction in conductivity and measured muscle activity?

I appreciate you sharing your experience.  I will pass on any info I come across - and believe me, I will searching!

Title: Re: Any treatments that work for femoral nerve damage?
Post by: Hiker girl on August 25, 2014, 07:25:16 PM
Hi Cahiker,

The abnormal  NCS/EMG study shows radiculopathy and denervation of vmo suggesting axonal damage of femoral nerve.  However, I had MRI's on lower back, hip and thigh and the nerves are beautiful.  It is like the dang nerves won't wake up.  And then I get those wonderful moments when there is no pain, walk is normal and then I feel the shut down about 30 min to an hour later. 

I am supposed to go to PT which has said there is nothing to be done.  Bah, I will do this at home.  Waiting on Neurology to agree to take me on.

I am also going to try acupuncture and a new thing cold lazer or something like that.  I have also ordered new pads for tens unit with a gel that conducts more electrical stimulus.

It is a journey we are on. 

I plan to ask my dr. about new technology that Israel has come up with to help paraplegics to walk.  Seems like it could help in this situation. 

Title: Re: Any treatments that work for femoral nerve damage?
Post by: Hiker girl on April 09, 2015, 06:00:25 PM

Neuro said femoral nerve damage resulting in tourniquet too tight and destroying the veinous valve.
~lotion that has lidocaine, neurontin and aspirin for pain
~pain pills
~Work hard to build other muscles to take over the medial muscles
~rollator/wheelchair combination to be as independent as possible
~handicap placard
~strong professional grade tens unit for pain and swelling.
~compression sock that goes above the knee and the tourniquet line

I hope all is well with anyone suffering from femoral nerve death....I mean damage  ;)
Title: Re: Any treatments that work for femoral nerve damage?
Post by: missmyknee on April 10, 2015, 08:36:54 AM
You might email Dr Dellon of the institute of peripheral nerve surgery. He is an excellent nerve surgeon. I used him for my problems. My ortho Dr referred me to him. He is located in Baltimore .

I emailed him in the beginning , explaining my problem. He answered me in 24 hrs.

Title: Re: Any treatments that work for femoral nerve damage?
Post by: Hiker girl on April 10, 2015, 04:52:47 PM
Thanks Pam