Banner - Hide this banner





Author Topic: HELP! How can I reduce the swelling?  (Read 1537 times)

0 Members and 1 Guest are viewing this topic.

Offline blusky_1

  • Regular Poster
  • ***
  • Posts: 123
  • Liked: 0
  • User's Text
    • My Webshots Albums
HELP! How can I reduce the swelling?
« on: September 25, 2003, 06:27:23 AM »
Had PT tonight and before leaving, he felt he had to tell me I need to get rid of the swelling (DUH!). When I arrived, it was swollen and after he did all his work on it, the swelling had doubled. He put the electrodes on, a bag of ice wrapped in a wet towel, and wrapped the leg in saran wrap for 20 minutes. That seemed to help a bit, and at least I could walk with only a mild limp when I left. (We won't get into the bruises I have from this session already!)

I've been alternating days between ibuprofen (800mg) and Naproxen 500mg. I've even been icing it at work, but I still have swelling. I called my OS's nurse and she said I should come back in (as if owing the OS $7000+ isn't enough for me!). The therapist also told me to wrap my leg in a bandage at night from mid-calf to mid-thigh. He said going back on the brace wouldn't help. Do I need to go back on crutches to reduce my weight bearing or something?? I don't know what I can do...between the ice and anti-inflammatories, you'd think the swelling would be minimal, as I'm 7 weeks post op this Friday. What can I do? If I can't get rid of the swelling, the knee will continue to get worse...UGH!

Brooke
Arthroscopy 8/8/03 - partial meniscectomy (x2), chondroplasty, lateral release (failed). 1/04 - dx with "miserable alignment". 11/04 - dx patella baja.

Offline Heather M.

  • SuperKNEEgeek
  • *****
  • Posts: 4007
  • Liked: 13
    • Check out my photography!
Re: HELP! How can I reduce the swelling?
« Reply #1 on: September 25, 2003, 10:16:04 AM »
Brooke,

Rampant, persistent swelling is one of the worst complications of a lateral release.  The surgeons make it sound like such a quick and easy surgery---but it cuts through soft tissue and completely alters your knee mechanics (the lateral retinaculum attaches to the quads for pity's sake!).  It is only to be expected that your knee is traumatized.

You are right that the swelling must be controlled, and it sounds like you are doing a lot of the right things.  At about 6-7 weeks post op from my LR, I was in the same situation.  My doctor put me on Celebrex and it initially helped a great deal--for weeks and weeks, actually.  Then I did something to it around Thanksgiving (3 months post op) and the swelling was out of control again.  After that we tried oral prednisone (steroid) and iontophoresis, and that helped for a little while, but the swelling always came back.  My old OS didn't know what else to do.  

My current OS treats the swelling very differently--if the knee was swelling, I had to do WHATEVER necessary to make it stop.  That included limiting PT to basic ROM stuff, going back on crutches, and not working--even though I have a sedentary desk job.  When you are at your desk, your knee is well below your heart, and the fluid just pools up in the leg.  Plus, when you sit with legs bent, that 'loads' the kneecap or puts it in contact with the joint.  Since you just had that sucker scraped and smoothed, it's painful to do that.....

You are probably right in that reducing some of your activities will help. It sounds like you need to talk to the doctor and see what else you can do to reduce the swelling.  Would it be possible to work from home?  Set up crates to elevate your leg at work?  Not run errands around the office or do stairs anywhere?  Get someone else to do grocery shopping and stuff while you are in this flare up stage?  

The swelling should pass, just hang in there.  You are very close to the point where most LR patients make a drastic turn for the better.  I remember at 12 weeks post op, once I had the swelling under control with the prednisone, I had almost two months of improvement.  But then I had serious mechanical issues in addition to post-op complicationes (bleeding in the joint) that caused a lot of trauma.  

It sounds like you were actually doing fairly well for a while, so maybe if you just give the knee a break for a couple of weeks it will calm down.  Sometimes the doctor will use a cortisone shot to help everything quiet down.  Soft tissue damage is a bear, but you can calm it down with lots of ice and TLC, and sometimes with interventions at PT.  Talk to your doctor about these--phonophoresis, iontophoresis, and so on.

Best of luck and keep us posted with your progress.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline blusky_1

  • Regular Poster
  • ***
  • Posts: 123
  • Liked: 0
  • User's Text
    • My Webshots Albums
Re: HELP! How can I reduce the swelling?
« Reply #2 on: September 25, 2003, 04:42:13 PM »
Thanks for the info Heather. I'm going to wrap my knee today and try to use the crutches. Unfortunately, I can't avoid stairs, as I live on the 3rd floor with no elevator. My concern was also in something that you mentioned. I had read about the post-op bleeding in the knee. I was wondering if that can happen thislate in recovery. Fact is, the swelling has never gone away...and the swelling after my therapy last night was awful! You should see the bruises I have from it! It looks like someone took a meat tenderizer to the pudgy area just below the knee towards the inside. Today, I'll try moving my rolling file cabinet over to where I can prop my leg while I work at my desk. I've been using a small step stool under the desk, but that is only about 8 inches high.

Well, I need to get my butt in action so I'm not late for work. Will call the OS today to see how soon he can see me...

Brooke
Arthroscopy 8/8/03 - partial meniscectomy (x2), chondroplasty, lateral release (failed). 1/04 - dx with "miserable alignment". 11/04 - dx patella baja.

Offline ATsoccergirl

  • SuperKNEEgeek
  • *****
  • Posts: 1394
  • Liked: 1
  • Practice safe sports, use an athletic trainer
Re: HELP! How can I reduce the swelling?
« Reply #3 on: September 25, 2003, 04:50:30 PM »
See if your physical therapist has access to a jobst pump.  This is a boot that goes from your toes to mid thigh and is hooked to a machine.  The machine inflates and deflates various sections of the boot to create a pumping action.  This is very effective at getting rid of swelling.  If you are using crushed ice or ice packs these can be done at the same time.  Depending on the what type of closure the boot has, electrical stim can be done at the same time.  

Electrical stim may or may not be helping, in order for it to help with swelling it needs to set up correctly, which unfortunatly very few sports medicine professional know how to do.  A biphasic waveform should be used over an interferential, which is the most commonly used.  The goal with this type of e-stim is to create a quick muscle contraction.  This will further the pumping action which will help pump the swelling into the thigh.  The negative lead should be placed over the area of swelling, with a dispersive pad further away.  There should be an equal on / off time.  This is very similar to russian stimulation, but it create a muscle pump by having short bursts of contraction.

Unfortunatly, swelling is one of the more serious complications of a lateral releases.  However, it is not a reflection of how religeous you've adhered to treatment, but rather a reflection of the surgeon's skill.  When done correctly, there is hardly any swelling.  I see one of the top surgeons in the country and had hardly any swelling.  I'm familiar enough with the surgical techniques of various surgeons in my area, just by looking at the amount of swelling I can usually tell who did the surgery.  

Besides the ace wrap, see if you can get a foam pad to put on the lateral aspect of the knee.  This will greatly increase the compressive forces.  You should have had this after surgery also.
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 blusky_1

  • Regular Poster
  • ***
  • Posts: 123
  • Liked: 0
  • User's Text
    • My Webshots Albums
Re: HELP! How can I reduce the swelling?
« Reply #4 on: September 26, 2003, 05:02:21 PM »
Well, I tried the crutches at work yesterday. I ended up just using one, under the left arm. When I went in on both, I managed to pull a muscle in the upper right of my back! A co-wrker rigged up a leg prop for me....flipped my trash can over under the desk and put my little step stool on top. It was perfect! I ended up icing the leg 3 times while at work, then again when I got home. Slept thru most of the night without pain. This morning, it seems a good deal of the swelling has disapeared.

What I'm curious about now is if anyone has ever come out of PT with serious bruises? Granted, I bruise easily, but I was on the edge of tears and holding my breath while the PT was rubbing the leg! Now it looks like someone beat the poop out of my leg, below the knee! Doesn't that sound like he was just a wee bit too rough?? I know therapy generally hurts, but leaving bruises is another story! I'm afraid to go back now!

Brooke
Arthroscopy 8/8/03 - partial meniscectomy (x2), chondroplasty, lateral release (failed). 1/04 - dx with "miserable alignment". 11/04 - dx patella baja.

Offline walsh7

  • MICROgeek (<20 posts)
  • *
  • Posts: 11
  • Liked: 0
  • User's Text
Re: HELP! How can I reduce the swelling?
« Reply #5 on: September 28, 2003, 01:46:09 AM »
I wanted to weigh in on the swelling issue.  My son had an injury in June.  We finally convinced our OS that he needed surgery and he had it on 9/13.  His swelling never resolved in the 3 months between injury and surgery.  As a result of the unresolved inflammmation,  he has bone spurs, and scar tissue.  He's only 16 and his knee is a mess.  Inflammation, commonly known as swelling, left unchecked can lead  to so much trouble later on.  He has used both Celebrex and Vioxx without much success.  I finally started using a nutritional supplement that has had results in 2 days.  It is bovine colostrum.  Look it up online and see if it appeals to you.  I wholeheartedly recommend trying this.  

Offline blusky_1

  • Regular Poster
  • ***
  • Posts: 123
  • Liked: 0
  • User's Text
    • My Webshots Albums
Re: HELP! How can I reduce the swelling?
« Reply #6 on: September 28, 2003, 03:17:04 AM »
Walsh...I also went approx 3 months from onset to surgery. I never actually knew of anything I did to injure it, and the reason the doc opted for surgery was that he couldn't get rid of the swelling and was concerned by it. Due to his numerous vacations, it was 7 weeks from the day I set the appointment to the day of surgery! He had tried a cortisone as the 1st option, and that caused excruciating pain the next day (and doubled the swelling), then I had a rash that the dermatologist said was rebound psoriasis due to the steroids! What a mess! I'll research the bovine colostrum though... :)

After two days of using the crutches at work, the swelling seems to have gone down some, but I can still tell it is there by the stiffness and lack of ROM. When I do my PT exercises, it starts to flare back up again. The stairs hurt like %^&) today! The dogs are low on food, but I know there's no way I can get a 37.5# bag of food up to the 3rd floor. I'll have to try to get a neighbor to haul it up here for me.

Fortunately, my bruising is already starting to disappear from the PT session! I almost wish they'd stay til Tuesday so I could show the OS when I see him! He's probably going to think I'm a hypochondriac when he sees me on his schedule...fact is, right now I'm thiking he's a poor surgeon, so we're probably going to be even! I was talking to a co-worker about the swelling the other day, and it turns out she also had the same 3 procedures. When I showed her what my knee looked like at 7 weeks post op, she gasped! She didn't have any problems with hers and couldn't believe I was that swollen so long after surgery! UGH
Arthroscopy 8/8/03 - partial meniscectomy (x2), chondroplasty, lateral release (failed). 1/04 - dx with "miserable alignment". 11/04 - dx patella baja.