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Author Topic: Synovitis and inflammatory neuropathy  (Read 88 times)

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Offline pomnatron

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Synovitis and inflammatory neuropathy
« on: June 10, 2020, 07:37:20 AM »
Hi all,

Been a long time lurker of this forum trying to solve what's been a life-altering and now chronic (hate that word) issue with my knee. It's come to the point where I need to be proactive about finding solutions/preventing further issues, so I'm here looking for some advice and direction. [Feel free to skip to end for my current issues and my main questions]

Not so brief background...I'm 26 years old. I tore my right ACL playing college football in 2013. Had it reconstructed (with patella tendon graft on same side). I got back to ~90-95% of previous level of athletic ability and didn't have any significant issues. Unfortunately, I re-tore the same ACL again in 2015 and proceeded to have it reconstructed with a patella tendon graft from my left knee (developed patella tendinitis from this so I regret having it done this way - fortunately mostly solved that through PRP injection). Ever since that surgery I have had ongoing and evolving issues. At some point following surgery scar tissue developed in the medial compartment of my right knee, making it difficult to run or strengthen my leg. I didn't get to more than 60% of my previous athletic ability, as both knees prevented my leg muscles from returning to pre-surgery levels and I lost all the fluidness and confidence that are required of an athlete, and so I medically retired in 2016.

My right knee would become swollen and stiff after sitting with bent knees for too long. Extension was measured to be in normal range, but the scar tissue/tissue irritation made it difficult to effectively contract my quad. Full flexion was prevented by crackling/resistance of scar tissue. My knee also just generally felt hot and irritated. After exhausting non-invasive attempts to resolve these issues (e.g., PT, yoga, anti-inflammatory measures), I had a right knee arthroscopy (believe they did scar tissue and partial plica removal) in 2017. This surgery actually improved my flexion and got rid of some of the scar tissue, but the irritation/inflammation returned after a week or so.

In 2018-2019, I got two PRP injections in my left knee (helped and mostly resolved ongoing patella tendinitis) and one in the right knee (did not help and maybe made slightly worse). Finally, after a lot of browsing of this forum, I decided to see Dr. Dye in early 2019. He did a bone scan and diagnosed me with synovitis and neovascularization of the fat pad. He recommended the envelope of function approach in addition to NSAIDs and if that didn't work then a kenalog (type of cortisone) injection. After about 6 months of reducing my activity level (though I'll admit as a 20-something year old living in a big city I did not do as good of a job as I could have), the issue didn't resolve.

Somewhere over the course of this story, I began developing sensitivity in my right knee. It was initially not all that noticeable and I'd categorize it more as discomfort/sensitivity rather than pain. Looking back, I wish I had spoken up about it sooner, but I think it was difficult to view this sensation independent of the acute synovitis-related pain in my knee. It all just felt irritated. Over time my knee became increasingly bothered by wearing pants (particularly certain fabrics like jeans), but I put up with it while trying to focus on solving my synovitis. Finally, in September of last year, things took a turn for the worse when the sensitivity/burning pain started spreading beyond my right knee to my thighs and calves on both sides, and to a lesser extent, my arms.

Coincidentally, I was scheduled to see Dr. Dye for the kenalog injection shortly thereafter and when I told him about these new symptoms he told me it sounded like neuropathy. He still gave me the injection (no noticeable positive or negative impact) and also prescribed me a low dose of gabapentin. When things didn't resolve, he referred me to a neurologist who after EMG and nerve conduction tests, diagnosed me with a mild inflammatory neuropathy with some sensory nerve damage. He explained that something triggered my immune system and told me the neuropathy and my knee issues were "separate but related" issues. He told me nerves do heal but slowly, and there wasn't much I could do to quicken this process.

So that's where I am at now. Still trying to address the chronic synovitis, but more bothered on a day-to-day basis by the neuropathy. My current regimen for the synovitis is ibuprofen (~600mg daily), topical Voltaren gel (started this less than 2 weeks ago but seems to be helping with localized inflammation a bit), icing 1-2 times a day, yoga/stretching, limited PT-type exercises (straight leg raises, glute clam shells, light RDLs), and also anti-inflammatory supplements (fish oil, cherry juice, turmeric). For the neuropathy, I am taking 1400 mg daily of gabapentin (not noticeably helping but neuropathy doesn't seem to have worsened) and trying to do light exercise (see above). The toughest symptom to deal with has been the allodynia (mine exhibits itself in burning pain/sensitivity from clothing), but I also have some light muscle spasms in legs, burning feeling in legs (mostly thighs and calves, though not that bad when not in pants), and infrequent electric shooting type feelings.

One final note to add. Not being at my desk job all day due to COVID-19 (currently working from home) has given me the chance to try to break the cycle of pain that I've been in and I feel that I'm making some progress, at least on my localized right knee issues. In retrospect, I should have been more willing to pause my life to address these issues, but it's a tough thing to do when I'd literally have to halt my professional/social life (as I'm sure many of you can empathize with). But regardless of what I should or shouldn't have done, I'm trying to make peace with the decisions (or lack thereof) that have led me to this point and focus on what I can do to improve my health/pain levels.

On that note, here's some information I am looking for:

-Any advice/resources to try to address either my synovitis or my neuropathy?
-Has anybody had similar issues that they have successfully addressed? If so, what were the main reasons for your improvement/recovery?
-Neuropathy vs CRPS - I've been diagnosed with neuropathy but curious if it might be worthwhile to seek a second opinion to confirm/rule out anything else such as CRPS which may have a different treatment approach.
-Would surgery (e.g., synovectomy) to try to address my acute right knee issues be crazy at this point with my neuropathy? (obviously want to avoid at all costs, but I still have scar tissue in my right knee so maybe it could address that and my inflamed synovial cells)


Thank you if you made it this far and apologies for the lengthy post! Beyond the physical pain/discomfort, it's been mentally and emotionally draining dealing with this, but it's always helpful to draw support (and hopefully solutions) from other people who have gone through similar trials.