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Author Topic: no one seems to know the cause of the pain :-(  (Read 34106 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!  :) :)

Offline KartBoy

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Re: no one seems to know the cause of the pain :-(
« Reply #15 on: August 16, 2012, 12:08:18 AM »
Hi Jasmine, I think I've seen your name on some of my posts but what is striking is your description of pain, I had it through eight surgeries and over last four and a half years. It certainly possible that its nerve damage, makes sense because mine just begins to build through the day just by staying on my feet, at my last consult I deliberatly kept of the meds for three hours before seeing the Dr but despite being in near agony it didn't tell him anything new. I've had hardware in and later out plus cartilage transplant (ACI) to no effect.
The only thing currentlly between me and plastic knee is specialist pain clinic as I just can't bear the pain/ side-effects of medication on my digestion & sleep.

Andy
7th Mar 08 - Pedestrian hit by car
10th Mar 08 - TPF (Plate + 6 screws)
12th Mar 08 - TPF Revision
Feb 09: Hardware removed + scope
Jun 10: ACI Stage I
Aug 10: ACI II (Stanmore)
Oct  11 - MRI + Scope (In pain)
Aug 12 - MRI + Scope (In more pain)
Sep 12 - TKR ruled out :(

Offline jasmin1989

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Re: no one seems to know the cause of the pain :-(
« Reply #16 on: August 26, 2012, 12:03:36 PM »
Hi Andy
yes I have responded to a few of your posts before.
I tried Lyrica for 3 weeks and it has no made a difference at all. I've stopped taking it and luckily have not experienced any of the withdrawal side effects.
I go for my MRI tomorrow. I'm hoping something will show up. It's very frustrating having doctors and physio's all disagreeing with each other regarding where the source of the pain is. My General Practitioner believes it's post surgical neuropathy, my physio thinks there is some kind of problem with the plica or fat pad, and my surgeon says "oh...it'll probably settle down..."
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 jasmin1989

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Re: no one seems to know the cause of the pain :-(
« Reply #17 on: August 29, 2012, 09:43:04 AM »
MRI results are in - although it provided no answers regarding the pain. All it found was parameniscal cysts on the lateral meniscus but no tears and thickened iliotibial band onto Gerdy's tubercle. I do sometimes get pain where the cysts are though which explains that.

I saw my surgeon this afternoon and he described the surface of the tibia like a cracked wall. you can patch it up but the surface will never be nice and smooth again. He also said it's possible that the fat pad tissue was damaged from the impact of the car hitting me and now there's scar tissue which could be causing pain. He also said to stop all exercises that work my knee and to forget about trying to build up muscle for now. Pretty much I can do upper body stuff or swimming. He's also referred me to another doctor for a 2nd opinion.
Feeling pretty down at the moment :-(
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 Stergios

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Re: no one seems to know the cause of the pain :-(
« Reply #18 on: September 02, 2012, 12:38:58 AM »
Hi Jasmin,
I have the same injury like yours in a car accident too in the same time as you. I had not an ORIF but my OS prefered to use external fixation on my tibial plateau, I don't know why, maybe he thought that this is the best method to heal the bone. Bone was really healed well, union is good, but I was operated for patellar tendon injury too. He used as smal wire put horzontally in my patellar tendon, that was removed with the rest of external fixation after 12 weeks from my injury. I had intense PT to increase ROM, but it never exceeded 100-105 degrees. I have my ACL torn too, as an MRI showed me. Limited ROM didn't permits me to increase stength on my quads and biceps, as a PT told me. About pain, a physiatrist prescribed me Lyrica, which was much effective on sharp knee pain, that my physiatrst described as neuropathic pain. I decided to take it for some months that is six so far. No much side effects except some dizziness in the morning and maybe some extra kilos (???). But I'm not completely pain free. I can walk very slowly, not much limb, but I have pain around my tibial plateau, like a vice biting my knee. It is not much, I could say it is 4/10, and it is when I am walking, never when I am sitting. It is in the external side of my knee. I have pain on my patella too when I try some squats and stretching exercises. It seems my tendon damage has much influenced patella motion in knee flexion. It is like my knee is blocked by something, restricting motion. I forgot to tell you that there is a loose body inside the joint as the MRI showed. My physiatrst tried some injections with Lydocaine on my knee surface with good results to knee pain, but it didn't last much. I think I have to repeat this therapy (mesotherapy) again. I'll have to resume all my situation to my physiatrist next week, after her summer holidays. I don't know if you have the same symptoms, maybe there some of them. Obviously my condition is much heavier than yours, I wish you good luck!

Offline mtlady

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Re: no one seems to know the cause of the pain :-(
« Reply #19 on: September 02, 2012, 07:33:56 PM »
Hi jasmin1989,

Did your OS ever mention giving you a shot of steroids in your knee?  If your fat pad is inflamed, this may calm things down.  Have you seen the Dr. he referred you to yet?  What kind of doctor is he/she?  I know the whole situation is very frustrating, but I think it's a good sign that your doc referred you to someone else and isn't just telling you to go home and deal with it.  Some advice:  keep a good record of all of your symptoms, test results, doctors seen, etc. etc.  It has really helped when I see a new Dr. to have a clear history to present to him - it helps the doc sort through your situation and shows how organized and concerned you are about your situation (they take you more seriously).

Keep us updated!

Offline PonyExpress

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Re: no one seems to know the cause of the pain :-(
« Reply #20 on: September 02, 2012, 08:20:16 PM »
I'm now 6 weeks post steroid injection in my fatpad, I'm 95-99% back to normal function. Def worth investigating.
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 KartBoy

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Re: no one seems to know the cause of the pain :-(
« Reply #21 on: September 02, 2012, 09:34:01 PM »
Hi Jasmin

With the pain in my knee getting worse in phases booked a private consult with Professor Briggs from Stanmore believing that more or less immediate knee replacement would be recommended. I had fresh MRI's and xrays done on the day and a week later went back to see him. He was a bit confused from the scans and told me he would need to do another arthroscopy, he was adament at followup that knee replacement would not fix the issue but couldn't tell me for sure what might. I'm waiting on a referral to pain clinic but at the moment am at a bit of a loss as no one can explain the pain, or more importantly why its much worse now than six months ago. This is four and a half years since accident and its got to the point that I'm now back using a cane for walks of more than five minutes.

Its aggravated by time on my feet but there is no visible swelling, the pain, which I can feel now is hard to describe but isn't sharp and doesn't come from movement of the joint. I've been thinking lately that its probably nerve damage so maybe if the pain clinic can't help then a nuerologist might be next.
7th Mar 08 - Pedestrian hit by car
10th Mar 08 - TPF (Plate + 6 screws)
12th Mar 08 - TPF Revision
Feb 09: Hardware removed + scope
Jun 10: ACI Stage I
Aug 10: ACI II (Stanmore)
Oct  11 - MRI + Scope (In pain)
Aug 12 - MRI + Scope (In more pain)
Sep 12 - TKR ruled out :(

Offline jasmin1989

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Re: no one seems to know the cause of the pain :-(
« Reply #22 on: September 03, 2012, 07:24:07 AM »
The doctor he has referred me to is another orthopaedic surgeon. Just waiting for them to ring me back with an appointment time.
None of my doctors have ever said anything about steroid injections. How long do they last?

I'm off the Lyrica now. Finished the trial pack and found it didn't really make a difference. I'll keep you all updated on how the appointment goes
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 #23 on: September 03, 2012, 01:37:03 PM »
As far as I know the steroid injection is permanent. The swelling had gone which has allowed the joint to heal. Im not expecting to have any more.
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 Vickster

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Re: no one seems to know the cause of the pain :-(
« Reply #24 on: September 03, 2012, 01:42:06 PM »
I realise it's not a knee - I had a steroid jab for tennis elbow in January which helped for 6 months...I have now had one PRP injection - my OS said he doesn't believe steroids work for TE as is down to damage to the tendon and not purely inflammation. 
The key to keeping a  joint happy that was once inflamed and now settled by steroid is to rest it and not do to it whatever upset it in the first place :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline KartBoy

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Re: no one seems to know the cause of the pain :-(
« Reply #25 on: September 03, 2012, 07:42:37 PM »
I had a steroid injection about three years back before hardware came out, hurt like h#&! and didn't make the slightest difference, but aside from immediately post surgery my knee wasn't swollen so different situation.
7th Mar 08 - Pedestrian hit by car
10th Mar 08 - TPF (Plate + 6 screws)
12th Mar 08 - TPF Revision
Feb 09: Hardware removed + scope
Jun 10: ACI Stage I
Aug 10: ACI II (Stanmore)
Oct  11 - MRI + Scope (In pain)
Aug 12 - MRI + Scope (In more pain)
Sep 12 - TKR ruled out :(

Offline jasmin1989

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Re: no one seems to know the cause of the pain :-(
« Reply #26 on: September 14, 2012, 05:24:26 AM »
Hi everyone
I just had my appointment with the other orthopaedic surgeon. He said after speaking to my surgeon and looking at my medical file, he believes the pain is originating from the fat pad. So he has suggested removing it. He also said it may or may not work - some studies even talk about the fat pad regenerating. I'm willing to try anything so we'll see how it goes.
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 KartBoy

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Re: no one seems to know the cause of the pain :-(
« Reply #27 on: September 19, 2012, 11:26:50 PM »
Jasmine:

The parallels between us are interesting, I have (in my words) a fissure or fracture ridge across the tibial plateau where the bone broke away, its fairly solid but isn't smooth. The ACI filled filled a defect in the cartilage but they can't do anything about the underlying bone as its living tissue, I had an above average ROM as a result of my martial arts training most of which came back after all the surgeries and physio which would be great if only the pain would go away.

I looked up neuropathic pain, found a good article in Wikipedia via Google but what I have, clearly to me at least is nociceptive pain which can come from blood vessels, bone, whatever and is best described as aching, can't change it by prodding, poking, walking, sitting, whatever but as ever your post led me to some useful information for my pain clinic on Friday.
7th Mar 08 - Pedestrian hit by car
10th Mar 08 - TPF (Plate + 6 screws)
12th Mar 08 - TPF Revision
Feb 09: Hardware removed + scope
Jun 10: ACI Stage I
Aug 10: ACI II (Stanmore)
Oct  11 - MRI + Scope (In pain)
Aug 12 - MRI + Scope (In more pain)
Sep 12 - TKR ruled out :(

Offline jasmin1989

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Re: no one seems to know the cause of the pain :-(
« Reply #28 on: September 20, 2012, 12:43:57 PM »
Hi KartBoy
I'm glad you've found some information. I'm not so sure on fat pad removal anymore. I've been reading lots of studies and talked to my physio. She has seen more harm than good from it. I see my normal orthopaedic surgeon next week and am going to ask about alcohol ablation of the fat pad and patellar denervation.
Good luck at your pain clinic appointment!
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 jasmin1989

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Re: no one seems to know the cause of the pain :-(
« Reply #29 on: September 27, 2012, 02:59:08 AM »
So the orthopaedic surgeon and I have come up with a plan. He said with the alcohol injections there is a risk that it will damage the cartilage and he said the knee denervation is too new in Australia and he'd prefer that I not be someone's guinea pig.

So I'm going to try an ultrasound guided injection of anasthetic and steroid - the anasthetic will determine if the pain is actually coming from the fat pad. If all goes well with that and the steroids, I should be relatively pain free for the next 6 weeks. Then I can either get another injection of if it doesn't seem to work too well he said he will trim the edge of the fat pad (where it's scarred). He said he would never advise a complete removal of the fat pad like the other surgeon said.
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 KartBoy

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Re: no one seems to know the cause of the pain :-(
« Reply #30 on: September 27, 2012, 10:25:55 AM »
Good luck with the steroid injection, sounds like it should give you some relief, and either way should help them to get a better idea of what might be behind the pain.
7th Mar 08 - Pedestrian hit by car
10th Mar 08 - TPF (Plate + 6 screws)
12th Mar 08 - TPF Revision
Feb 09: Hardware removed + scope
Jun 10: ACI Stage I
Aug 10: ACI II (Stanmore)
Oct  11 - MRI + Scope (In pain)
Aug 12 - MRI + Scope (In more pain)
Sep 12 - TKR ruled out :(

Offline jasmin1989

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Re: no one seems to know the cause of the pain :-(
« Reply #31 on: October 19, 2012, 07:47:12 AM »
Finally success! I had the injection today. The doc injected straight anasthetic into the skin first (that felt awful!). Then he did the steroid/anasthetic into the fat pad. When I got up I felt like part of my knee was missing. It was a wondering feeling not having any pain. As per what my orthopedic surgeon said to do I tried squats, lunges, jumping, hopping, running on the spot, stairs and there was no pain! But 3 hours later the anasthetic has worn off. fingers crossed the steroids kick in and do their job.

Also at least now the docs and physio can be certain that the pain is coming from the fat pad.
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 #32 on: October 19, 2012, 06:40:53 PM »
My fat pad injection has worked since the day it was done :)

That's 3 months ago now, haven't looked back!
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 #33 on: October 20, 2012, 07:23:15 AM »
Hi PonyExpress - so it worked immediately for you? I'm back to pain today, plus it feels all stiff - but was told that can happen.
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 #34 on: October 20, 2012, 02:16:06 PM »
Oops! I'd forgotten, it wasn't great for 2 to 3 days immediately afterwards, but from then on inflamation and pain has continued to reduce.

Funny how your memory forgets pain (eventually).

Don't lose hope yet, it's early days x
« Last Edit: October 20, 2012, 02:18:49 PM by PonyExpress »
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 #35 on: October 28, 2012, 12:17:26 PM »
Trying to still stay positive but it's been over a week since the injection and it feels like my knee is worse. It's so achy and stiff (like it's full of glue)

Would love if my knee could be pumped full of anaesthetic again!
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 jasmin1989

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Re: no one seems to know the cause of the pain :-(
« Reply #36 on: January 11, 2013, 05:03:14 AM »
The steroid injection never worked so I opted for a fat pad debridement. Unfortunately, it's now 3 weeks later and it still feels the same. I saw the arthroscopy pictures  and he had to remove sections of scar tissue and the section of the fat pad was inflammed, but the pain is still there when I bend with weight.

He did say the surgery might not work and that the pain could be due to the actual fracture. I saw the image of this and was surprised. The bone on the tibial plateau is all smooth but where the fracture is there is no smooth surface, it's just cracked and bumpy, but nothing else can be done about it.

So it looks like I'm stuck with the pain. I'm going to find out about pain management clinics in the city where I live. Anyone got any experiences with pain management clinics?
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 KartBoy

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Re: no one seems to know the cause of the pain :-(
« Reply #37 on: January 13, 2013, 08:31:15 PM »
I've been to the initial consultation for RNOH Stanmore's pain clinic which if I'm honest was really an assessment of how much pain I was in and a medication review. At the time I was on 5/ 6 Tramadol a day which wasn't enough so they put my on a 5 microgram/hr Bu-trans patche which meant I could cut back a bit on tramadol, the other thing they do is pychiatric, things like group therapy to help you mentally deal better with pain although since I'm already having sessions with pyschotherapist who who's also helping me with depression Stanmore can't to much more.

Personally, don't give up yet on finding a cause, there are lots of people in (not just on this site) in a lot of pain and I think its one area where we as patients need to stop just accepting that they don't know what to do next and insist that they figure something out. I remember talking to one doctor for the purposes of a medical report who had personal experience of extreme pain (for her luckily, short -term, a few weeks) and it completely altered her perspective in regard to patients in pain.

Having now seen the court appointed pain specialist I can now seriously chase the Peripheral Nerve injury unit at Stanmore in the hope that they can make a difference.

Until then, Jasmin & Everyone keep your chin up, life isn't great but its a new year and we are not beaten yet

Andrew
7th Mar 08 - Pedestrian hit by car
10th Mar 08 - TPF (Plate + 6 screws)
12th Mar 08 - TPF Revision
Feb 09: Hardware removed + scope
Jun 10: ACI Stage I
Aug 10: ACI II (Stanmore)
Oct  11 - MRI + Scope (In pain)
Aug 12 - MRI + Scope (In more pain)
Sep 12 - TKR ruled out :(

Offline flatpik6

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Re: no one seems to know the cause of the pain :-(
« Reply #38 on: July 18, 2015, 03:06:45 PM »
Jasmine1989,

Just found this thread and find it closely aligned to my situation. Would really like to know how you are now and if you found any meaningful relief to your pain.