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Author Topic: Therapy for arthrofirbrosis  (Read 1328 times)

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Offline silver14

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Therapy for arthrofirbrosis
« on: July 01, 2012, 07:04:32 AM »
I find all different answers for this but, what seems to be the best type of therapy for arthrofibrosis.  I have a medial tibial plateau stress fracture and have developed RSD and arthrofibrosis.  I am now being put through hell with therapy.  All I can say that it is torture.  I have lost 40 degrees of extension and they are literally holding my knee at 5-0 degrees extension for 7 mins while every, and I mean every, tendon and muscle from my crotch to my toes cramps, tightens, pops and will not let go. I have been brought to  tears every time I go to therapy and I am not a crier.  Post therapy I am literally in bed, on pain meds and sleeping. I sometimes do not even eat, just sleep. My ortho has me currently taking neurontin, percocet,  and soma, which help but do not last and do not completely eliminate my pain.  The swelling in my knee and calf goes back and forth, but my foot is at least 3x the size of my other foot and just won't de-swell. I recently got a JAS brace, which works on a gradual stretch to complete extension, per my ortho and therapist on Monday i have to bring my brace in and it will be set to 0 degrees extension and I will have to have in on for an hour.  I am at 38 degrees now turning it approximate 6 x during my 3 half hour periods of wearing it daily.  I do not know how I am suppose to wear this for an hour at 0 degrees and tolerate this.  There has to be a better way of getting rid of this dam scar tissue. My ortho is pretty set against surgery at this point. I am 4 months post injury and only getting worse,  any suggestions out there??  I am getting very depressed at this point and am at my wits end. 

Offline kneepaincure

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Re: Therapy for arthrofirbrosis
« Reply #1 on: July 01, 2012, 07:37:31 PM »
This page might help you: http://www.kneeguru.co.uk/KNEEnotes/node/2268. Surgery might be necessary to get rid of the scar tissue if physical therapy is not working. 4 months is a pretty long time to wait for scar tissue to break up, and it needs to be dealt with soon.
Have had tilted kneecaps for many years, and occasional patellar tendinitis.

Offline Lottiefox

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Re: Therapy for arthrofirbrosis
« Reply #2 on: July 01, 2012, 10:18:13 PM »
You say you have both RSD AND arthrofibrosis? Are both of these being acknowledged in your rehab schedule? In terms of AF rehab check out the posts and diary by Renschenke, Missmyknee and others in the AF section. From my limited knowledge pushing to this extreme point of pain is not likely to be helping. RSD brings a whole new dimension into play (I have it in my toes after foot surgery last year). Further surgery on a joint with RSD is heavily contraindicated. has anyone spoke to you of spinal blocks to assist the RSD pain and give you a window to work through the AF rehab? How was RSD diagnosed?

You have a heavy set of issues going on there. Please check out the AF section and you might want to post this question again down there. There are MANY people who might be able to offer more specific advice.

Good luck,

Lottie  :)
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 kneepaincure

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Re: Therapy for arthrofirbrosis
« Reply #3 on: July 02, 2012, 01:02:40 AM »
^ Oh right, I totally missed the RSD part. That's a big complication to the AF problem.
Have had tilted kneecaps for many years, and occasional patellar tendinitis.

Offline silver14

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Re: Therapy for arthrofirbrosis
« Reply #4 on: July 02, 2012, 04:46:41 AM »
Thanks everyone, my ortho has diagnosed me with RSD because of the sudden onset of pain and swelling really out of proportion for my injury.  And the arthrofibrosis was dx by him also because of the 40 lack of extension and swelling I guess.  I semi agree on the RSD dx, I had some sensitivity, and still do, but its to pressure touching my leg, foot, knee feels like it is bruised.  I do not have the extreme sensitivity.  I have bad muscle spasms in my foot and leg and sharper and aching pain in my knee, and te swelling is unbelievable especially in my foot.  I have not been weight bearing since April. This therapy seems like true torture to me, I am not a crier, raised three boys on my own, I am usually very tough, but this is honestly braking me. I want my leg back again!!!!

Offline Lottiefox

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Re: Therapy for arthrofirbrosis
« Reply #5 on: July 02, 2012, 01:58:32 PM »
Hey,

I think you need the RSD diagnosis exploring a little more and to seek a surgeon with experience of AF if at all possible. I see you've posted down on the AF board and I hope someone can help you. This type of excruciating therapy doesn't sound like it is going to help either your AF or the possible RSD. RSD does need to be active; the killer for RSD is to do nothing but clearly if you have a scar tissue block in your knee you cannot engage fully in PT and try and beat the RSD into behaving. Hypersensitivity doesn't always exist in RSD - do you have any strange colour changes, temperature issues with period of extreme cold in the limb or burning heat? Any skin changes..typically RSD brings some shininess with the skin or unusual hair growth patterns. The muscle spasms can exist with RSD as they are linked to the nerves misfiring, and swelling can happen across the whole limb.

I really think you might need to try and hunt out an opinion from someone who can look at both issues. Are you receiving pain management? RSD is complex, and if you do have it then it needs proper management. If you do have it, then the AF diagnosis needs to be treated alongside it, to give you the best chance of recovery.

Good luck and keep us posted,
Lottie
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 silver14

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Re: Therapy for arthrofirbrosis
« Reply #6 on: July 03, 2012, 01:08:27 AM »
Lottiefox, thanks, yes I am seeing pain management doc on 7/10.  I dont have a choice unfortunately of which doctors I get to see.  I have excellent medical but it is managed care, they subcontract this ortho group and in the past have been very good, yet at this point, I agree they do not know what to do with me.  I called the ortho today after another day of excruciating therapy. They physically held me at 0 or so degrees of extension also with a 5lb weight attached to my ankle as I again went right into unbearable muscle spasms from my crotch to my toes.  This they do for 7 mins which seems like eternity, but today for added fun, they held me there and put on my JAS brace at 0 degrees extension and made me wear it, it was unbearable, I was actually begging them to take it off,finally they told me they would take it off if I walked with my crutches around the whole therapy office. It took every bit of strength I could gather just to stand with the crutches, I am still no weight bearing, I took around five steps slowly then basically ran, lol, just to get back to the room to get the brace off, which is now too small around my calf because it was measured to fit on a day that I had no swelling.  I left and called my ortho in tears and now have a consult with one of his associates on Thursday. I am also waiting for approval for appts with a rheumologist and vascular doctors. Hopefully this will happen soon.  I am hoping out of all these doctors there is at least one who will come up with a better solution.  And last but not least my ortho today said not to return to therapy until I see the pain management doctor.  So we will see what happens.  Thanks for the support.