Scar Tissue-Nerve Entrapment......A Second time
If you've been following my stories about scar tissue, you will know that I previously had scar tissue compressing the infrapatellar branch of the saphenous nerve. This was back in 2005. It was surgically debrided , decompressed and excised in 2006.
Once again, I've been diagnosed with the return of scar tissue, only 7 weeks post-op. The surgery I just had was for open debridement of scar tissue and a procedure called a proximal z-plasty. I did all the correct post surgery protocols for scar tissue. This consisted of gentle, non-aggressive PT, anti-inflammatories, icing, crutches patella mobes........ but it has formed once again. That is the horrible part of arthrofibrosis. I never know where scar tissue will appear. I've had it form just about everywhere, in my knee.
All the burning , tenderness, and throbbing pain I have been feeling across the front and medial side of my knee, is from scar tissue compressing the infrapatellar branch of the saphenous nerve, once again. It's not in the same area as before. The first time was near the MCL , now it is just above the medial jointline, running across the front of the knee, to just below the patella. This time it is in 4 areas of the nerve. The term Neuroma was used.
The doctor gave me 2 cortisone shots to the anterior knee and placed me on double dose Celebrex for 1 week. The next step after that is a medrol dose pak and a medication for nerve pain called, Lyrica. If there is no improvement then the next step will be surgery to remove the nerve. The ice machine and crutches will keep the knee from being irritated and swollen.
The morning after my diagnosis, I experienced extreme pain on the medial side of my knee, that woke me up. This was a sharp, unrelenting, throbbing pain. I could not lay still. I took pain medication, celebrex and used the ice machine , but nothing touched the pain. The best way to explain the severity of the pain is this: If I was a wild animal, I would have chewed my leg off. I was watching the clock for the doctor's office to open. I was supposed to be heading back home on this morning. There was no way I could handle a 10 hr drive, with this much pain. We thought I would have to stay an extra day.
Unfortunately, this was the doctor's surgery day. I found out they had a full surgery schedule and would not be coming back to the office. I talked to the head PT. He had me come right over to the clinic. He wanted to use e-stem to see if it would help with the nerve pain. He used the pain setting which provides a continuous current and did 2 different pain programs. The first program involved 2 electrodes placed on the medial side of my knee, one distal and one proximal. The continuous current ran between those 2 electrodes for 20 minutes. I could still feel pain when it was over, which made me feel skeptical, this would help. The second program involved placing a second set of electrodes on the lateral side, running distal and proximal. This time the 4 electrodes were hooked up so the current would run crosswise, in front of the knee. This ran for 20 min also. The Gameready ice/compression system was used at the same time. After the second stem program , the pain was gone. I could not believe e-stem could provide that much pain relief. I was able to travel home.
Pain control lasted about 2 hours, before the pain returned, but it was more managable with pain medication and icing. I have a home e-stem unit that is programmed for pain modalities besides muscle stimulation. I have been using my home e-stem to help with pain control.
Time will tell if scar tissue continues it's compression and surgery is needed to alleviate this problem.
This is an update at 15 weeks post op
Since I had the 2 cortisone shots at the end of November 07, which did not bring any change in the nerve symptoms, I've gone on to have 8 more of these horrible pain episodes. The longest lasting was about 36 hours. When these episodes happen all the daily pain, burning, sensitivity, needle jabs and throbbing become magnified 100 times. There is nothing that aliveates nerve pain. I went on to try 2 different medications used for nerve pain. The first one I tried was Neurontin. I took this medication for 3 weeks. I saw little change in the pain. I could not drive for over a week because of feeling "drunk". I was then placed on a medication called Lyrica. I could only handle taking this medication for 11 days. I never want to take this med again. I had terrible side effects. I could not drive until it got to be evening, when that effect started to wane. I also suffered lack of concentration and memory loss. I was forgetting things my family told me. I finally had to keep a pad and pen to make notes to myself. I suffered blurred vision. After 11 days , I could not handle it as I need to have the ability to drive and function on an intelligent level. I stopped taking the med cold turkey and went thru a 2 day withdrawl. It was not a pleasant feeling to go thru . I had a total of 4-5 hours sleep in 2 days time, jittery, visual problems, headache, couldn't sit still and increased heart rate. This medication was not for me.
I had a return visit to Dr Noyes. He is trying one more treatment option before resorting to removal of the nerve. He doesn't want to resort to removing the nerve as it can be difficult and can flare up other nerves. Two places were located on the nerve elicting the most pain. Lidocaine was injected into those sights to numb the nerve and follow the pathway by the numbness. I still had a small area of burning pain so that part of the nerve was injected with the nerve block. The area between the 2 nerve blocks was then injected with cortisone so coverage would spread between the 2 nerve areas. He is hoping this will settle the nerve down and removal not needed. If this doesn't work , then the nerve will be removed. This is a very painstaking surgery to have done.
I should know in about 6 weeks, if this is needed.
Note: You can read the rest of my story and surgery on my on going thread on the bulletin board. Go to page 10 on my thread and start reading on reply #136. This starts off with my surgery and beyond.
Scar tissue nerve compression is very painful !