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Author Topic: no one seems to know the cause of the pain :-(  (Read 34104 times)

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Offline jasmin1989

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no one seems to know the cause of the pain :-(
« on: July 16, 2012, 01:22:09 PM »
Hi
Had a TPF in April last year. Surgery to put a plate and 11 screws plus bone graft in April and got it removed in November. Ever since the first surgery I have had this pain below and underneath my knee cap on the inner side. My surgeon first put it down to complications with the hardware so he took that out and did a scope. He found that the cartilage needed some cleaning up but otherwise it all looked ok. However I still had the same pain. He then said it was probably to do with the muscle imbalance pulling on my knee cap and the pain would go away as I developed more muscle in my VMO. However, I've been seeing my physio and doing all of the exercises building up the muscle and the pain still remained. He then said the fat pad might be inflamed so to stop doing all lunges and squats which makes the pain worse.

I've done some research on fat pad pain and I'm not sure that's what it is. My pain is more on the inner side and sometime spreads around to the top of my knee cap.

For the past week I've had particularly bad knee pain. I saw my physio on Friday and she felt around my knee and said she thinks the plica is quite inflamed.

It's just frustrating that no one knows the exact cause of the pain. Even more frustrating is that I'm only 23 and used to be a dancer. I'm starting to doubt that I'll ever go back.

Has anyone else been in this kind of situation where it seems no one knows the cause of the pain?
2011
24/4 Hit by a car
10/5 - Surgery 1 plate 11 screws, bone grafts
Started physio, NWB for 6 weeks
21/06 PWB for 2 weeks then increase
start Aug - down to 1 crutch
30/08 - driving again
29/11 - Hardware removal & arthroscopy
18/12/12 - Fat pad debridement & scar tissue removal

Offline PonyExpress

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Re: no one seems to know the cause of the pain :-(
« Reply #1 on: July 17, 2012, 06:24:33 PM »
Saw my OS today, I'm 10 weeks post op and am having pain on the medial side of my knee which extends over my knee cap when bending my knee. This is preventing me from actively getting ROM although passively there is nothing stopping it.

OS thinks it is inflamed fat pad and gave me a steroid injection into the fat pad. I go back in 6 weeks time and if no improvement he says he might have to go in and reduce the fat pad.

The pain can be quite sharp if I have been using my knee alot and sometimes it feels as if it is having a spasm internally on the medial side. Knee also looks a bit puffy on the inner side.
19th Feb 2012 Damaged knee falling off horse, banged leg on jump
18th Apr 2012 MRI indicated significant bone bruising
30th Apr 2012 EUA arthroscopy, MUA, MFX medial femoral condyle
17th Jul 2012 Cortisone injection into Fat Pad

Offline mtlady

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Re: no one seems to know the cause of the pain :-(
« Reply #2 on: July 22, 2012, 08:20:08 PM »
Hi,

Your pain sounds like it could possibly be caused by nerve pain, more specifically the saphenous nerve.  This nerve can get damaged during knee surgery, and in some cases is aggravated by exercises that activate the quads (squats, etc.).  You may want to ask the doc about this - it is a cause of pain often overlooked or unknown to many doctors.  This is just an idea, of course, as there are many causes of post-surgical knee pain. 

mtlady

Offline KinnaMarie

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Re: no one seems to know the cause of the pain :-(
« Reply #3 on: July 23, 2012, 04:02:25 AM »
Jasmin,

Seriously reading your post is almost a mirror of my situation.  I too am 23 and had a different knee surgery and have had nothing but trouble since.  My OS too thought I was having trouble because of the hardware so he removed it and that did nothing.  I've had a total of 4 surgeries within a year and a half, and no one still knows why my knee is still hurting and why I am having trouble.  I have been in PT this whole time and doing everything possible, but whatever I do seems to make it worse.  They thought it was muscle weakness, nerve issues, allergies, infection, DVT, and blood issues, but nothing is making sense...yet my knee is swollen, bruised, hot, and hurting.  I too am beyond frustrated and last week I decided to just give up.  I was very athletic, but now just have to accept that I will never be able to play competively...  My OS kept saying he doesn't know what else to say, and neither do I so I decided to just be done because I seem to have no other option.  It sucks, but I thought I would let you know that we have a very similar situation. 

Best of luck!   

Offline jasmin1989

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Re: no one seems to know the cause of the pain :-(
« Reply #4 on: July 23, 2012, 08:56:57 AM »
Thanks for the replies.
I will be sure to ask my doc about nerve pain.

KinnaMarie, I've considered giving up and just living with it but I can't. There are too many things I want to do that are restricted by this pain.
I also suppose that as my injury was due to a lady hitting me with a car, despite the fact that I had the green pedestrian walk sign. I want her insurance to pay for every possible option to discover the cause of this pain.
2011
24/4 Hit by a car
10/5 - Surgery 1 plate 11 screws, bone grafts
Started physio, NWB for 6 weeks
21/06 PWB for 2 weeks then increase
start Aug - down to 1 crutch
30/08 - driving again
29/11 - Hardware removal & arthroscopy
18/12/12 - Fat pad debridement & scar tissue removal

Offline PonyExpress

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Re: no one seems to know the cause of the pain :-(
« Reply #5 on: July 23, 2012, 09:28:22 PM »
Well, it's now nearly a week since the steroid injection into my fat pad. The inflamation has reduced such that the operation portals are now almost flat. The pain is greatly reduced and I'm begining to feel really hopeful that it was fat pad inflamation causing my pain.

Apart from stopping some of your exercises, did your OS mention giving you a steroid injection? Might be worth talking it over with him, possibly nothing to lose and everything to gain.

Good luck.
19th Feb 2012 Damaged knee falling off horse, banged leg on jump
18th Apr 2012 MRI indicated significant bone bruising
30th Apr 2012 EUA arthroscopy, MUA, MFX medial femoral condyle
17th Jul 2012 Cortisone injection into Fat Pad

Offline jasmin1989

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Re: no one seems to know the cause of the pain :-(
« Reply #6 on: August 01, 2012, 06:13:36 AM »
My OS has never mentioned giving me a steroid injection. I'll have to see what he says.
I went and saw my normal doctor today and she thinks it's post surgical neuropathic pain. She also said that there's not really anything that can be done except pain relief medication so she's starting me on Lyrica to try. Has anyone ever taken Lyrica?



2011
24/4 Hit by a car
10/5 - Surgery 1 plate 11 screws, bone grafts
Started physio, NWB for 6 weeks
21/06 PWB for 2 weeks then increase
start Aug - down to 1 crutch
30/08 - driving again
29/11 - Hardware removal & arthroscopy
18/12/12 - Fat pad debridement & scar tissue removal

Offline mtlady

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Re: no one seems to know the cause of the pain :-(
« Reply #7 on: August 01, 2012, 09:49:17 PM »
Hi jasmin1989,

I have nerve (neuropathic) pain in my knee area and there are some people on this site that also have post-surgical neuropathic pain.  Some people do respond well to medication like Lyrica for their nerve pain.  I have tried Lyrica, amitryptiline, and Neurontin for my pain and it helped slightly.  I don't really agree with your doctor that "nothing can be done" for nerve pain.  Nerve pain can be difficult to deal with, but there are options.  Some people respond well to getting an injection near the nerve that contains anesthesia plus a steroid ("nerve block") to calm it down - this can be done by a doctor trained in nerve block injections (pain management doc, anesthesiologist, neurologist, etc.).  Some doctors prescribe pain medicine cream or patches that you can apply to the painful area.  In severe cases, a procedure to deaden or remove an irritated nerve may also be an option.  I am having surgery in September for my nerve problem.  There are a few others on this site that have had nerve surgery as well.  In some cases, scar tissue from a knee injury or surgery can build up and put pressure on the nerve, so the scar tissue needs to be removed.  Of course, with all surgeries, there are risks. 
Like I said, some people respond well to medication and don't need anything else.  I hope you are one of them!  If your pain is really bad, maybe you should talk to your doctor about seeing a pain management doc or a neurologist.   

mtlady

Offline KinnaMarie

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Re: no one seems to know the cause of the pain :-(
« Reply #8 on: August 02, 2012, 04:00:07 AM »
Hi Jasmin,

So my OS will not let me give up and he will do everything he can to help, so giving up is not an option for me anymore.  You have also helped encourage me to find answers!  My OS keeps saying he thinks in CRPS/RSD, but I had 3 different tests and 2 doctors that said it is not, but he whispers whenever I see him that he thinks that is part of my problem.  So you could maybe ask about that? To help with the post surgical neuropathic pain he did put me on Lyrica.  I took it for about a month but it was not doing anything for me.....until I stopped taking it.  So my biggest advice to you if you do take Lyrica is to not just stop taking it!  On top of everything else going on I had the worst drug withdrawl.  I was sick for a week, could not sleep, and could not stop crying.  It was terrible!!!  So do not stop cold turkey!  For the nerve issue, my OS also sent me to a pain management doctor and he suggested a series of 3 shots in my spine called a lumbar sympathetic block.  I at first said no, but my PA and OS said yes so I went for the series and those made my leg very warm for a couple hours after the shot, but didn't do anything else.  So the sympathetic blocks could be another option for you to ask about. 

Hope this kind of helps and let me know!

Offline silver14

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Re: no one seems to know the cause of the pain :-(
« Reply #9 on: August 10, 2012, 09:56:20 PM »
Jasmin1989,

As in the previous posts, I would pursue looking into nerve damage or irritation.  It is a hard animal to tame and dx.   :)
But there are many treatments that may help.  Unfortunately you may have to go through many different types of treatment before you find what helps you.  It can get very discouraging, but don't give up.  My thoughts for the drs. is that there has to be a reason your body is telling you that you in pain and they must try everything to find it.  You are very young and hopefully put you in a good position for complete recovery if you continue to push for an answer. My thoughts and prayers are with you for this to happen.

Offline jasmin1989

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Re: no one seems to know the cause of the pain :-(
« Reply #10 on: August 11, 2012, 01:52:51 PM »
Thanks for the replies. I haven't had a good past few days. Plus this is all complicated by my whole medico-legal case.  Seem to be in tears constantly   :'( Have not noticed any relief from Lyrica yet.
mtlady, please keep me updated on your nerve surgery. what exactly are you getting done? I wish I could get nerve ablation in my knee. I would rather not be able to feel anything.
Saw my orthopedic surgeon on Thursday. What did he say? "Oh I think it will settle down" My response "Well you've been saying that for OVER a year now and the pain is not settling down!" he then said to get an MRI. But an MRI wouldn't show up anything to do with nerve pain though right?
Finding it hard to be positive  :(
2011
24/4 Hit by a car
10/5 - Surgery 1 plate 11 screws, bone grafts
Started physio, NWB for 6 weeks
21/06 PWB for 2 weeks then increase
start Aug - down to 1 crutch
30/08 - driving again
29/11 - Hardware removal & arthroscopy
18/12/12 - Fat pad debridement & scar tissue removal

Offline silver14

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Re: no one seems to know the cause of the pain :-(
« Reply #11 on: August 11, 2012, 02:53:49 PM »
Sorry to hear about your frustrations, but has anyone mentioned CRPS/RSD, a bone scan is sometimes helpful with dx this, or a lumbar block.  I would seek treatment with a pain management dr. and see what he has to say on the subject. Again this can be so frustrating, sometimes your drs get just as frustrated as you, and just don't know what to do or how to treat you, My sanity came with seeing my pain management dr.  I had a stress fracture of my knee 6 months ago and developed CRPS.  I''ve been seeing my pain management and have had a lumbar block with temporary relief, it was about one week, so I am going for me second one this coming week with the hopes that it will last longer.  But as you said anything is better than the pain. Keep your head up, and it's ok to cry, we have all had our "pity parties".  Good luck and keep us updated.

Offline mtlady

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Re: no one seems to know the cause of the pain :-(
« Reply #12 on: August 14, 2012, 09:18:25 PM »
Hi jasmin1989,

So sorry you are feeling frustrated!  I can totally sympathize.  I had to see a number of doctors in a number of different places before I could find the right one.  Please don't give up! 

I agree with silver14 that CRPS/RSD could be a possibility, and that you should try to seek out a pain management doc.  He/she could do more tests, like the ones mentioned by silver14, plus maybe even try a nerve block near your knee to see if that relieves your pain. 

When I go for my surgery in Sept, the surgeon is going to try and relieve pressure or tension on my saphenous nerves in both legs.  He thinks that there may be some connective tissue that is either pressing on the nerves or constricting them, causing pain ("nerve entrapment").  If that surgery does not help me, he will then just do a neurectomy (removal of saphenous nerves).  I had considered getting a nerve ablation too, but one of my doctors said that my insurance would not cover it.  I am having my surgery at Massachusetts General Hospital by a doctor trained in peripheral nerve surgery.  It took me a while to find a doc that had experience with this type of problem - and someone on this site helped me find him (this person had their saphenous nerves removed by him after the nerves had been damaged from knee surgery). 

It's probably good that you are getting an MRI just to rule other things out.  But nerve problems can't always be seen in MRI, so don't let them just write you off if the MRIs are normal.  I had three MRIs on my knees and they could never find anthing out of the ordinary.   

Keep us updated!

mtlady

Offline MyKnee2010

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Re: no one seems to know the cause of the pain :-(
« Reply #13 on: August 14, 2012, 11:50:11 PM »
Hi,

I'm sorry to hear of more people having nerve problems. I am the person MtLady mentioned who had severe damage to my saphenous nerve in both legs. In my left leg, the saphenous nerve had grown through the sartorius nerve. I think it happened after the first scope I had. In my right leg, the saphenous nerve had extensive damage - no way to know what caused it but it seemed to happen after I had the TKA on that leg.

I had awful burning pain from the big toe up to the thigh in each leg.  I had several docs try to do a nerve block on the saphenous nerve but it never helped at all. The nerve surgeon gave me about a 50% chance of success because the nerve blocks didn't work on me. He operated on the right leg last June & the left leg last September. He ended up disconnecting the saphenous nerve in each leg due to the type & amount of damage he found.

The surgeries helped quite abit but I still have pain in both knees. It appears that the remaining pain is probably due to mechanical issues with the knees, or my theory is that my problem with calcium collecting in my knees is reappearing with the calcium building up around the kneecaps. I have an appointment with my new OS (#4) in about a month (4 weeks & plus several days MtLady!!) so hopefully I will learn more then.

Keep trying to get answers. I have blown through several OS & primary docs now because they all tried a few things & then told me to just live with the pain. No way!! I'm older than the rest of you (52 yrs old) but I'm not ready to give up anything I used to do!

Take care!

Offline silver14

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Re: no one seems to know the cause of the pain :-(
« Reply #14 on: August 15, 2012, 05:25:36 PM »
Jasmin1989,

MTlady and the rest are right, keep pushing for answers, it will be the only way to at least get some relief if not complete relief from you pain.  Do not let them tell you there are no answers or help for it. Again, I do believe these types of answers come from the drs frustration and knowledge of what is wrong.  You will find the correct dr., they are out therre  :).

Unfortunately along the way you will come in touch with many who, in no other words that I can think of, ignorant, of your problem.  I have had my share of that, and it has only been six months that I have been dealing with CRPS, already.  I end up getting very defensive then very frustrated and crying over there ignorance.  It passes and I pick myself up and get mad at the way I was treated and move on.  I do think it is good to let it out, it has kept me from becoming totally depressed about my current situation, I try and stay focused on the hope that there is an end to all this craziness and I keep my sights set on that, especially when I am having my low days.  But if you are not able to get out of that "funk" and are getting depressed it is ok and good to seek out some psychiatric help, because chronic pain and also come along with depression and this needs to be treated too, just as much as your pain.  Medico-legal or not they cannot deny you this treatment, it will only look bad for them in the end if they do. 

Hoping things are getting better, keep your head up!  :) :)















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