First time back

I'm getting ready for my first appointment back with my pm dr since having surgery to remove my knee caps. My legs are significantly weaker and there's a lot of pain. My right knee is bone on bone and the left has stayed swollen since surgery and both knees are prone to hyperextension (incredibly painful). Up until the surgeries I was managing well on a low dose of Norco twice a day. Now that doesn't begin to put a dent in it. How do I relate this to him? I don't want him to think I just want more drugs but I do want the pain managed so I can have a life. I don't feel like he always listens to me.

Hi Angelic Victory just be honest with your PM, tell him how bad you hurt, and when it is worse or better, and what affects it, and ask him if there is anything he can do to make the pain more manageable. Don't ask for more or stronger medications, just ask him to help you better manage your pain. Let him or her know your problem and situation, and then let him decide what can be done to treat it. Allot of doctors don't like to be told by their patients on how to treat them, so you are better off, just letting them know what is bothering you, and then ask them to help you. Most doctors are more receptive to this approach, and your more likely to get better treatment. It is not always the case, but I have found it works allot better than allot of other ways.

I wish you all the best, and of course keep us posted on how you make out at your appointment.

Good Luck to YOU!

White Beard

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Moderator Chronic Pain
USAF retired in Sept.1991. I went back to school and became a licensed RN in 1994, I worked on Oncology and Med Surg, Disabled in late 1999, was approved SSD in early 2002! Diagnosed with: DDD and Multiple herniated Disks; Foraminotomy L3/4/5 Jan 2013; Posterior Articular Joint fusion Nov 2010; C5/6 ACDF Sep 2009; C6/7 ACDF 1985; Implanted pain Pump Jun 2014.

Angelic_Victory since you said your right knee is bone on bone, wouldn't that make you a good candidate for a total knee replacement? And might that not be better in the long run for you? Just wondering why that wasn't done in the first place. My sister had total knee replacements done on both her knees, and she has excellent mobility and can do just about everything. I've also had a total knee replacement done on my right knee, and although it took me allot longer to recover and get the swelling down, but with extra physical therapy, I have finally got really good range of motion without pain in it now!

Anyway I was just curious as to why they done that type of surgery verses the total knee replacement?

I do wish you well and hope things work out for you!

White Beard

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Moderator Chronic Pain
USAF retired in Sept.1991. I went back to school and became a licensed RN in 1994, I worked on Oncology and Med Surg, Disabled in late 1999, was approved SSD in early 2002! Diagnosed with: DDD and Multiple herniated Disks; Foraminotomy L3/4/5 Jan 2013; Posterior Articular Joint fusion Nov 2010; C5/6 ACDF Sep 2009; C6/7 ACDF 1985; Implanted pain Pump Jun 2014.

Angelic:
Working with your pain mgm physician on a referral to a sports-medicine physical therapist seems like a strong idea to work towards in your upcoming visit.

The patella (aka "knee cap") is a small sesamoid bone that lies in the tendon of the quadriceps muscle. The patella provides mechanical leverage to the quadriceps muscle, enhancing the efficiency and strength of the quadriceps. That is, the patella places the quadriceps in an angle such that the physics of the quadriceps muscle is improved and enhanced.

People without a patella report similar symptoms and complaints that you have. Instability of the knee, pain, swelling/inflammation. The knee, as a hinge joint, relies solely on the muscles and ligaments that surround the joint. There is inherently no bony stability to the knee joint as there is bony stability to the hip joint, for example. The knee joint depends on muscular strength of the quadriceps (anteriorly) and hamstrings (posteriorly), as well as the anterior and posterior cruciate ligaments and medial and lateral collateral ligaments.

That you are hyperextending the knee is likely due to muscular weakness. Hyperextension of the knee, repeatedly, causes ligamentous laxity that then promotes continued hyperextension. The hyperextension problem increases - in both frequency and in the degree of displacement of the femur in relation to a fixed tibia.

It could well be that your knee pain (bone pain), swelling, and cases of hyperextension would ease given attention to a monitored and graded program with a sport-medicine minded physical therapist.

This is not to say that you should not pose the need for pain management support . . . you should be discussing your needs for pain control with your pain management physician.

But I am suggesting that surgical removal of the patella does dictate the need for a focused physical therapy program. The quadriceps muscles is at a mechanical disadvantage without a patella. Muscle re-education and strengthening is vital for the knee after resection of the patella. Little wonder that you knee is sore, hyperextending, and swollen.

While your pain management MD can ameliorate your pain in the short-term, the long-term management will entail a qualified physical therapist that will strongly work 1:1 in partnership with you.

I am a physical therapist by profession and would be happy to query any concerns/questions that you may have of any PT who works with you. As with any profession, there are good physical therapists and less than good physical therapists. Trust your instinct. If a PT is not a good fit for you or if the sessions and advice just feels "off," look elsewhere until you find a PT that you feel comfortable with and who is skilled in the skill set that you need.
- Karen -

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Pituitary failure, wide-spread endocrine dysfunction
Addison's disease
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)

My kneecaps were underdeveloped and constantly dislocating. They were damaging the bones around my joint. I'm in my early thirties so my dr didn't want to do a tkr at this point. I will be having them but he would like to wait 10 years or so.
I do use ice packs and wraps on my knees. I have a few different braces and the ice us the best way to treat the swelling. I can't take nsaids. I'm seeing my pain management dr on Monday. I'm definitely going to request the pt. I'd love guidance on the best ways to build muscle. I'm at a loss. I have a tens unit that I got after the first surgery because my quad wasn't firing for a while. I'm unsure what is considered safe. I've had a few falls and it's so hard to get out of the floor. My surgeon just continues to say I've exceeded his expectations, which isn't helpful. I'd just like to be as mobile as possible. I'm a single mom with 2 ****s. I know I will have limitations but I'd like to do as much as I can. I'm not afraid of pain but I need it managed so I can continue being the mom the kids need. Thank you so much. The wraps you looked at, would they be able to be worn while moving around the house? Right now I have to sit down to Ice.