Banner - Hide this banner





Author Topic: LOA & MUA round 2  (Read 19490 times)

0 Members and 1 Guest are viewing this topic.

Offline mouk786

  • Regular Poster
  • ***
  • Posts: 139
  • Liked: 0
Re: LOA & MUA round 2
« Reply #15 on: September 01, 2011, 01:50:14 AM »
Is it advised to 'go for the kill' straight after surgery - or i nthe first coupel of days - to push as hard for most ROM as you can or do they suggest slowly building it up over time?

I would have though straight after surgery was the best time to try and max out ROM because your knee will be most clear - but at the same time clogged up from swelling.


Offline Decruz

  • Forum Faithful
  • ****
  • Posts: 352
  • Liked: 0
Re: LOA & MUA round 2
« Reply #16 on: September 01, 2011, 02:50:16 AM »
Your OS has to advise how to use it following surgery.
In my case my OS always with 0°-70° in the bed post-op (I woke up in the CPM already) and from the 2nd day at home I was told to increase as tolerated, without forcing but feeling in the last 3°-4° flexion degrees some resistance.
PT told me to go as far as the knee went as well, time was not a concern (if few days post-op I was already able to bend until 100° then work on that limit without forcing, if I was able to bend like 120° then the CPM limit became 120°) so in my case as I quickly regained a max flexion that overpassed the CPM max flexion limit (mine CPM reached 120°, if I remember well) PTs said once I was over 120° CPM was no longer actually necessary, only thing was that using it I kept the knee mobile (it should help to avoid adhesions) so I kept using it for the 1st post-op month no matter what flexion I regained (obviously wit a 0°-120° setting).
Defintely don't force, never, but reach the knee limit feeling some resistance (not too much, but the feeling it's stretching tissues a bit to get flexion) in the very last degrees - if after 30-60 min the last degrees resistance is mostly or completely gone than increase of 1° and see.
Never force on pain
Decruz

"Forward..."

Offline Stasha83

  • Forum Faithful
  • ****
  • Posts: 226
  • Liked: 0
Re: LOA & MUA round 2
« Reply #17 on: September 01, 2011, 09:51:17 AM »
Hi All

Lottie - no muffins i'm afraid, the pain was just too bad to do any baking. Hopefully be able to do some over the weekend to keep myself amused. The boredom is relentless at the moment! I like the idea of your soggy sock! It'll be interesting to see how you get on with Reflexology, it would be great if it helps. I'll keep my fingers crossed.

My swelling is still pretty controlled, the main areas are directly above and below the patella. It''ll be interesting to see what the knee looks like once the swelling at the bottom of the knee has gone down as this is where I think it will look noticeably different without the fat pad. I'm still getting quite a lot of bruising coming out but i'm not surprised, my poor old knee must feel pretty traumatised!

I'm seeing my OS for a review and to have my stitches removed this afternoon so looking forward to getting his opinion.

Decruz - I'm not sure if anyone really knows why AF comes back? Obviously if there is a specific trigger, say you have an accident or you know you have continually pushed it too hard and ignored the warning signs then that could be a cause.

I haven't got an obvious reason as to why my scar tissue returned, we did everything right as far as I know. Do you know why your scar tissue returned?

The reason my OS is hopeful that this time round may be different is that we have removed the remainder of the fat pad which is a known cause of some of my inflammation. I'm hoping that now the fat pad has been removed my knee wont be in a constant state of inflammation and therefore reproduce scar tissue. Well, fingers crossed anyway!

Mouk786 - Thank you for the note of your OS. It's always good to get more names of UK based surgeons who are dealing with AF, we seem a bit short of them here! Perhaps if you are pleased with him you could eventually name him on here too?

My CPM was set based on what my OS and hospital physio decided. The physio wprked with me and then they decided that -3 (as far as the machine will go to for extension) and 90 flexion would be a good place to start. I'm now up to 110 and hope to go up to 120 next week. My machine goes to 130 and like Decruz, once I have reached this I will continue with the machine for the movement to try and stop those adhesions forming. I have it booked for a month at the moment but last time I kept it for 6 weeks. I'm not sleeping on it (although I can as it's pretty quiet and gentle) and just use it throughout the day, an hour on and then an hour working on extension, back on the machine for another hour etc. Your OS should advise you what schedule is best for you.

Will you be able to get enough physio on the NHS? When I tried the NHS after my original op they wouldn't offer me more than 1 session a week which wouldn't be enough for me. I have a private physio which is expensive (£45 per session) but to me it's worth it. When I approached my NHS physio about AF they hadn't even heard of it let alone know how to rehab someone with the condition!

I think crutches are a good idea, the rehab protocol on here for AF says not to load the knee for the first week or 2. I'm on crutches and think I'll need them for a good while yet.

One other thing worth mentioning to your OS this time round is pain control, it might be worth having a plan in place incase you find that you do need more meds this time round, especially after the op as you'll be doing physio and CPM pretty soon after the surgery. In February I had a femoral nerve block and this time round I had an epidural, mainly so that I could cope with rehab so soon after surgery.

Right, I'm off for a stint on the machine now!

Stasha
June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline missmyknee

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 2084
  • Liked: 23
  • From the Land of OZ
Re: LOA & MUA round 2
« Reply #18 on: September 01, 2011, 09:45:41 PM »
Hi Stasha

This is in reference to Decruz's question as to why scar tissue came back.  I've had scar tissue come back many times even though everything has been done. Here is a link to my thread before my current thread was started. The title says it all........I DID EVERYTHING RIGHT AND STILL GOT SCAR TISSUE

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=38179.0

PAM
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline mouk786

  • Regular Poster
  • ***
  • Posts: 139
  • Liked: 0
Re: LOA & MUA round 2
« Reply #19 on: September 01, 2011, 11:07:35 PM »
regarding NHS physio - found it is both inconvenient and poor quality. I had 3 NHS Physios who didnt notice the scar tissue the first tiem and my surgeon was a little critical of them after I went to see him like 6 months post Op and my knee was terrible (it was also not picked up by 2 registrar surgeons).

My hospital of choice is quite a bit away from where I live so I also have a private physio near me who I use. To be honest I know all the drills. The physio is good for mobilisation work though - which I wil utiilise.

NHS physio of 1 session per week sounds about right and then it gets less over tiem - it is very 'hands off' due to time contraints.

Offline Stasha83

  • Forum Faithful
  • ****
  • Posts: 226
  • Liked: 0
Re: LOA & MUA round 2
« Reply #20 on: September 02, 2011, 11:46:38 AM »
Thank you for posting the link to your thread Pam. I knew I wasn't alone with this!  :)

My NHS physio (after original op last June) failed to recognise all the classic signs that I had scar tissue forming too. Frustrating because if they had I would have had a much better chance of recovery than I am faced with now. I moved to my private physio about a year ago, to be honest I would never go back even if I had a problem totally different to my knee.

After the AF surgery in February I saw my physio 5 times a week for the first 2 weeks. I know this sounds a lot but it was because I wasn't confident to go it alone at that stage. This time round I am much more confident and am happy to rehab at home so I'm seeing my physio once a week at present but I may increase this to twice a week in a few weeks time when the knee has calmed down a bit more.

I saw my OS yesterday. My stitches have been removed and he is pleased with my progress. My knee is pretty angry though so I need to be extra careful with it. It is a fetching shade of purple, red and green! He was happy with my ROM and advised that we will stick with the basic rehab and CPM for a further 4 weeks with a view to adding more strengthening etc after this period. He reiterated that I need to work really hard on the extension as it would be all to easy for this to slip away. I am determined not to let this happen though!

So all in all I think things are going ok at the moment. I really wish some of this pain would go away though, if anything the pain seems to be creeping up rather than decreasing.

Stasha
June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline Lottiefox

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • Posts: 2393
  • Liked: 16
Re: LOA & MUA round 2
« Reply #21 on: September 02, 2011, 03:15:18 PM »
Hi Stasha

I get so frustrated that our NHS Physios do not seem to be able to recognise complications. That has nothing to do with staff levels, funding etc - it is a basic lack of training and understanding and evaluation of the patient. I honestly think I could go and rehab someone with a knee or foot problem and spot the signs of scar tissue or CRPS earlier than so called experts!

Good to hear that your OS is pleased with your ROM. I am impressed by the rainbow effect you seem to be cultivating! Not so good that the pain isn't abating. You have some nerve pain issues don't you? I know they can come and go and mine were probably at their peak some 2-3 weeks after surgery then gradually they've abated. Constant pain wears you down. Does anything help? Can you get the leg wet now? I keep sticking my foot into Epsom salts either in a warm bath or in a damp sock wrapped round my toes. Really seems to help the puffy feeling I get when my foot is tired. Not sure how suitable that would be for you.

I reckon you deserve a treat. Something pretty and sparkly often cheers me up.  :P ;D  Have you checked out Fabulous the jewellery shop - they have an online shop. Some lovely things, leave the page open for other half to spot.. :P

Take care and I hope the weekend is bit easier for you, I know how hard you're working on this knee and you deserve a break. I've just had a proper Indian Head massage - I am thinking of reflexology but this is a new therapist and I kind of wanted to meet her and judge her and show her my foot before I let her loose! She was lovely, very thorough so I think my foot will get some TLC soon, as will the matching non chopped one. She has hypermobile toes and can lift her big toe off the ground and bend it nearly right back to her foot without moving her other toes! Weirdsville!

Hugs,

Lottie xxx
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline mouk786

  • Regular Poster
  • ***
  • Posts: 139
  • Liked: 0
Re: LOA & MUA round 2
« Reply #22 on: September 02, 2011, 05:16:17 PM »
I agree that it is due to staff training but that always goes back to funding one way or the other.

My private physio told me that the training is poor on the NHS - i.e as a private physio he often spends a lot of his own money going on training seminars - whereas training on the NHS is fewer and far between.

He also said there is an element of being able to hide behind a big corporation o the NHS

Finally, and I think it is a good point, I think NHS physios are less likely to criticise surgeons. If the registrar surgeon says you knee is getting better (like mine did) then the physio is very unlikely to disagree IMO even though I was telling them it didnt feel right big time - because the surgeon is above them in the NHS. A private physio on the other hand has much more freedom and was always pushing me to ask the surgeon quetsions and offered to write a letter for me highlighting his concerns.
« Last Edit: September 02, 2011, 06:47:23 PM by mouk786 »

Offline missmyknee

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 2084
  • Liked: 23
  • From the Land of OZ
Re: LOA & MUA round 2
« Reply #23 on: September 02, 2011, 06:27:14 PM »
Hi Stasha

Sounds like you had a good OS appointment. ROM will be a long process and the earlier you can establish it, while tissues are still soft and pliable, the better. Keep doing patella mobes several times a day to keep the patella moving freely. For extension try doing hanging weights. Do this at least 6 times a day for 10 min. This works by causing a gradual consistent stretch to tight tissues. I did this for 6 weeks to get to 0 extension. It does work. Here is a link from Dr Noyes AF tutorial, on doing over pressure for extension and flexion. Complete with pictures. Page down to this info

http://www.kneeguru.co.uk/KNEEnotes/node/2064

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline captainruss

  • SuperKNEEgeek
  • *****
  • Posts: 675
  • Liked: 9
Re: LOA & MUA round 2
« Reply #24 on: September 02, 2011, 07:17:19 PM »
Stasha,

I am fortunate as my wife works at a Veterans Association Hospital taking care of our brave veterans and we have excellent medical insurance.  My problem is I am at 60 degrees flexion after 2 hours of intensive PT only to have my knee tighten up after ice.  I started with a MUA three weeks ago and the OS could only get it to 30 degrees as he was afraid he would break my leg.  I am new to this blog and trying to get answers.  I had a TKR 15 months ago, I have had probably 25 cultures/tests and all cultures come back negative, yet all 3 OS and all 3 infectious disease doc's tell me my knee is infected.  They rely on my c reactive protein and ced rates as indicators of infection.  I just found out about AF and now think these levels show inflamation, not infection.

I actually had my knee joint removed last October by OS #2 and I now believe it was not infected, I just had AF.  I had scar tissue, knee was hot, purple...and until I was able to see my spinal/shoulder OS who put my joint back in....I was considering amputation. 

I have tried nerve blocks during surgery and it has worked only once in the last five operations.  I had actually told the anesthesiologist to not put me under until I confirmed the nerve block worked.  The last two surgeries, the block did not work and he put me out.  The nerve block really makes recovery easier to me as less pain medication is necessary.  I have such a tolerance to high amounts of oxycontin, that I take more medication at home than they give you when leaving the hospital. 

My big question is i have had three MUA's, one with each OS and if they don't take out the scar tissue first, it is a waste of time.  My current OS is wonderful, but he admits he has never seen scar tissue as thick and pervasive as mine.  My OS is going to take out the scar tissue in 3 weeks and I am trying to find as much info for him as possible.  I am at a "catastrophic rate" with my insurance which means I pay no copays/deductibles until the first of the year.  I have to get this fixed this year as I have been out of work for 15 months for the first time in my life.  My wife is working overtime and we are in trouble. 

My OS 1-2-3 did not know to keep my knee moving after surgery.  I am now trying to be on a CPM as much as possible,  but my hip and back spasm after a couple of hours.  It also slides across the bed and the velcro pulls apart because the scar tissue squeezes my knee.  My knee is different because i shattered my knee cap at 17 and I am not sure if I even have a fat pad.  I am actually pretty tolerant of pain after having multiple spinal fusions, rotator cuff repairs, etc.  I am unfortunately very tolerant to high amounts of opiates as one of my first doctors increased my dosage to 3 times the maximum recommended amount of oxycontin for years.  I am now at 1/3 to 1/2 of what I used to take....but it is less effective.  I had not heard of Lidocaine Plasters or lidoderm patches.  Has anyone had results from these? 

Thanks all........Russ
80 Shattered patella 5 surg
09  TKR 
09  MUA
09  MUA
09  Knee infected??
10  TKR  Scar Tissue
10  2nd OS  Diagnosis Infection
10  TKR with antibiotic spacer, no joint
4/11  TKR
11  TKR PT
11  TKR
11  TKR  AF diagosis
12/11  HO diagnosed
2012  Intractable Pain
2012  OS split
amputation possible?

Offline Lottiefox

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • Posts: 2393
  • Liked: 16
Re: LOA & MUA round 2
« Reply #25 on: September 05, 2011, 06:25:05 PM »
Hey Stasha

How are things going? Been thinking of you and hoping the extension is maintaining and improving.....how is the pain feeling? A quick question about your Lidoderm patches if you don't mind. Are they prescribed through your GP? Do they do anything for you? I am thinking I might ask to try them on my toe and try and wean down on my tramadol as it makes me feel so weird some of the time. I hate it. I'd rather try and patch on my foot and maintain the Lyrica and Epsom Salt sock wraps!

Let us know how you're doing,

Hugs,

Lottie xx
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline Stasha83

  • Forum Faithful
  • ****
  • Posts: 226
  • Liked: 0
Re: LOA & MUA round 2
« Reply #26 on: September 06, 2011, 10:23:56 AM »
Hi Lottie

Things are pretty much the same with me except for Sunday night the knee became hot and red which frightened the life out of me. I don't understand why it got angry, I didn't leave the house on Saturday or Sunday, just did my usual rehab plan. I really hope it doesn't do that again any time soon, I don't think my nerves could take it! The pain is pretty much the same but the knee is going a bit more purple which is nice.

The patches aren't available on the NHS here, nothing that I need is! I do have a private prescription for them but it's over £100 for a months supply. My statutory sick pay can't quite stretch to that sadly.

I think it would be worth you giving them a try if you can get them, you can cut the patch into smaller bits so it would be able to go on your foot or even your toe. I cut each patch into 3 or 4 strips so that I can surround the knee with them.

I'm so used to drugs now that the Tramadol does nothing for me. I've swapped to Fentanyl patches instead but these don't seem to do anything either?! I must be immune to all of these strong drugs!

June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline Stasha83

  • Forum Faithful
  • ****
  • Posts: 226
  • Liked: 0
Re: LOA & MUA round 2
« Reply #27 on: September 09, 2011, 05:47:35 PM »
Hi all

My patella is beginning to get tight again despite doing plenty of mobes every day. I've also had an increase in pain levels since my physio session on Weds.

Does anyone have any ideas as to what I can try to loosen the patella? I feel that I can't push it much harder, especially as I've had this increase in pain but not sure what else I can do?

Any advice appreciated.

Stasha
June 2010 - R knee TPF & Hoffa removal
Dec 2010 - R knee- Arthrofibrosis
Dec 2010 - L knee Myxoid degeneration of meniscus
Jan 2011 - R Knee 11 steroid injections & Synvisc1
Feb 11 - MUA & LOA
June 11- Steroid inj, EMG & nerve tests
Aug 11 - MUA & LOA
Feb 12 - R Knee denervation

Offline kcknee

  • Forum Faithful
  • ****
  • *
  • Posts: 375
  • Liked: 54
Re: LOA & MUA round 2
« Reply #28 on: September 09, 2011, 06:12:43 PM »
Stasha-

This suction cup device is what I have my PT use to keep my patella moving. He can then lift it slighly up and then mobilize it. I got the set, I think throuigh Amazon.com, because I wasn't sure of the size cup I needed, but I only use the yellow cup.

http://www.bannertherapy.com/ProductInfo.aspx?patella-mobilizer-set&number=95-550

When my patella was getting really stuck my PT remembered something like this in his PT training programs. It took a while to find it on-line. For me, it works great.

Good luck and I hope you can keep progressing forward.

Kristin
« Last Edit: September 09, 2011, 06:15:41 PM by kcknee »
12/31/08 - Skiing injury L knee
6/1/09 - ACL stump removed from joint
8/31/09 - ACLr - Hamstring Graft
12/21/09 - Ant Fasciotomy 
8/26/10 - Anterior Interval Release
12/6/10, 5/5/11, 12/22/11 - Fasciotomy
12/7/12 - Nerve Decompression
6/3/13(m), 7/29/13(l), 12/13/13(m & foot) 2/3/14(l) Fasciotomy

Offline Lottiefox

  • SuperKNEEgeek
  • *****
  • *
  • *
  • *
  • *
  • Posts: 2393
  • Liked: 16
Re: LOA & MUA round 2
« Reply #29 on: September 09, 2011, 07:59:37 PM »
Hi Stasha

I can't offer anything practical but I hope the patella can be kept free. That looks like an interesting device that Kristin recommends, I can see the logic. I hope your pain levels settle down. I know so little about AF but I really hope this surgery brings you some relief and function. Been thinking about how you're getting on this week. Any progress on the baking at all?!  :P  It is exhausting dealing with pain every day. I am trying to get in to see my pain doc as I've had a few rough flare ups with my toes and I am not sure quite what is going on. I have this big red hard lump on my toe joint - not the fused one, the little one by the end. Its so strange, and painful at times. Can bend it all OK, but its totally numb, I could saw it open and wouldn't feel it. I don't see RSD as being described like that but who knows, it seems to be as unpredictable a beast as AF. We're so special!

Have a good weekend, I hope you get some pain free time to relax.

Lottie xx
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....















support