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Neurology (Expert Forum)
SEVERE atrophy/pain in left quad/knee area, been struggling for 5 years.
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SEVERE atrophy/pain in left quad/knee area, been struggling for 5 years.
by Emil77, Dec 06, 2002 12:00AM
My info: 25 year old male, 5-10, 215lbs.
Problem: SEVERE atrophy in left quadriceps/Severe knee pain.
History: June of 1997 I had a patellar-tendon transfer knee surgery. Medical name is Roux-Goldwaith procedure. After the surgery, I start the physical therapy, etc. After 3 months of physical therapy there is no new development in quadriceps muscle. The orthopedic doctor says "It will take time, continue to do physical therapy."
2 years go by, again no development in muscle. I go to a different orthopedic doctor. He does x-rays, says "everything is ok." He sends me to a Neurologist for an EMG test. Results are "normal."
Jan 02-Develop major pain again in knee. New orthoped does MRI/Xrays, everything normal. Says there is pressure in kneecap, preventing developement of muscle. Performs surgery to relieve pressure. I go to physical therapy. Again, NO muscle growth. July 16, 2002, I am sent to pain doctor. He performs a Left lumbar sympathetic nerve block. Again, I go to therapy and NO results. Pain is still present in the kneecap, that whole area hurts. November 6, 2002-New neurologist, EMG/NCV tests are again mormal. MRI of brain/spine to rule out ALS. Dec 4, results are given. Says there is no evidence of ALS. In 2 weeks,I am going to UCLA medical center for another opinion. I am at the end of my rope with the pain. I can not run, go up stairs normally.
Pain is always there. I had a whole 3 page post written with doctors quotes but there is not enough space to write it all. I used to be very active. Any ideas?
Problem: SEVERE atrophy in left quadriceps/Severe knee pain.
History: June of 1997 I had a patellar-tendon transfer knee surgery. Medical name is Roux-Goldwaith procedure. After the surgery, I start the physical therapy, etc. After 3 months of physical therapy there is no new development in quadriceps muscle. The orthopedic doctor says "It will take time, continue to do physical therapy."
2 years go by, again no development in muscle. I go to a different orthopedic doctor. He does x-rays, says "everything is ok." He sends me to a Neurologist for an EMG test. Results are "normal."
Jan 02-Develop major pain again in knee. New orthoped does MRI/Xrays, everything normal. Says there is pressure in kneecap, preventing developement of muscle. Performs surgery to relieve pressure. I go to physical therapy. Again, NO muscle growth. July 16, 2002, I am sent to pain doctor. He performs a Left lumbar sympathetic nerve block. Again, I go to therapy and NO results. Pain is still present in the kneecap, that whole area hurts. November 6, 2002-New neurologist, EMG/NCV tests are again mormal. MRI of brain/spine to rule out ALS. Dec 4, results are given. Says there is no evidence of ALS. In 2 weeks,I am going to UCLA medical center for another opinion. I am at the end of my rope with the pain. I can not run, go up stairs normally.
Pain is always there. I had a whole 3 page post written with doctors quotes but there is not enough space to write it all. I used to be very active. Any ideas?
Doctor's Answer
by CCF-Neuro-M.D.-JT, Dec 14, 2002 12:00AM
I know your space is limited for the post, but more information would be helpful such as the circumstances around the surgery in 1997(was it for ACL reconstruction, was there trauma involved, was there direct injury to the quads, what complications there were, etc...). There appear to be 3 issues in your post and I'll try to address them that way: 1)atrophy of the quads 2)severe pain 3)question of ALS.
1.According to my orthopedic colleague, you shouldn't have atrophy in the quads if it was just a routine ACL reconstruction/repair which is what patellar-tendon transfers are usually done for, unless there are other circumstances such as direct trauma to the quads that was not stated above. And it's surprising that the EMG is completely normal if there is severe atrophy as you report, unless they did not sample the quads. Unfortunately, the details of this procedure are out of the neurologic arena and would best be answered by your orthopedist.
2.Again, the problem appears to be ortho-related rather than neurologic. Steroid injections directly into the knee may be of help rather than sympathetic nerve blocks. Neurontin has also helped patients with nerve type pain. A pain management specialist may have more ideas.
3.The symptoms do not sound like ALS as they appear to be localized to the knee and have been for 5 years. Also, the normal EMG helps make ALS an unlikely possibility.
If you would like to list more details regarding the quadriceps atrophy in a comment rather than a new post, I will be happy to answer on this string. Sorry for the wait.
1.According to my orthopedic colleague, you shouldn't have atrophy in the quads if it was just a routine ACL reconstruction/repair which is what patellar-tendon transfers are usually done for, unless there are other circumstances such as direct trauma to the quads that was not stated above. And it's surprising that the EMG is completely normal if there is severe atrophy as you report, unless they did not sample the quads. Unfortunately, the details of this procedure are out of the neurologic arena and would best be answered by your orthopedist.
2.Again, the problem appears to be ortho-related rather than neurologic. Steroid injections directly into the knee may be of help rather than sympathetic nerve blocks. Neurontin has also helped patients with nerve type pain. A pain management specialist may have more ideas.
3.The symptoms do not sound like ALS as they appear to be localized to the knee and have been for 5 years. Also, the normal EMG helps make ALS an unlikely possibility.
If you would like to list more details regarding the quadriceps atrophy in a comment rather than a new post, I will be happy to answer on this string. Sorry for the wait.
The pain is caused by an abnormal feedback loop between your spine and the nerves in your extremity so that you feel pain in the extremity. You may also have muscle atrophy, poor motor control of the limb, and various physical changes like swelling, discoloration, temperature changes, and unusual hair growth. (Not all of these may occur).
If you go to read literature about RSD, you will be distressed because doctors sometimes write that it is a psychogenic condition or that it is more common in people with "dependent" personalities. DON'T BELIEVE IT. It can happen to anyone, even young athletes who want nothing better than to run again.
There is hope. In many patients, the pain fades with time-- although to be realistic, it may never completely go away. You will learn your own strategies for getting what exercise you can. You can also try acupuncture, heat or cold treatments, stretching, massage, etc.
I'm not saying this is what you have. But you might look into it. Take care, and please keep trying.
Unfortunately with the limited space we have, I was not able to type out my full report. :-)
Yes, the doctors have mentioned it could be RSD or CRPS. I hate that diagnosis. Why should I have it?
The lumbar blocked helped, but now I am getting that itchy feeling again. Your right, I do have some color change, swelling of the knee and poor motor control. Sometimes my knee gives out and I fall, I can't raise my leg straight up, or extend it from a sitting position. The pain is INTENSE when I do that!!! I am thinking about trying Prolo-Therapy. Ever heard of it?
I have an appt on the 20th to see a specialist at the U.C.L.A. Medical Center.
Thanks,
Emil
Before trying Prolo-therapy, do some serious research. The little that I do know about this treatment, which involves the injection of caustic/irritating substances around the spine, sounds extremely concerning. This topic comes up a lot among patients with pain of spinal origin. In general, inflammation in and around the spine/spinal nerves/spinal cord is more often linked with causing these chronic pain syndromes than it is with curing them. Based on the substances that are injected, there is a risk that such a treatment might just make a patient worse.
Unfortunately, one has to be vigilant in avoiding further harm from poorly studied treatments. The treatment of spinal-origin pain has a long history of previously-tried invasive procedures, all well-meant, that only served to injure the spine