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Author Topic: no one seems to know the cause of the pain :-(  (Read 34105 times)

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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















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