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Neurology (Expert Forum)
2nd time asking-1st time no response from doctors.
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2nd time asking-1st time no response from doctors.
by Emil77, Dec 14, 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. Could it be Complex Regional Pain Syndrome? Please help, 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. Could it be Complex Regional Pain Syndrome? Please help, any ideas?
Doctor's Answer
by CCF-Neuro-M.D.-JT, Dec 14, 2002 12:00AM
Please see answer to prior post for more detailed comments.
Complex regional pain syndrome or reflex sympathetic dystrophy is a burning/nerve type pain syndrome resulting from some kind of trauma like a minor injury or surgery. It is usually associated with autonomic features which means there are skin changes in the affected area, smooth and shiny, loss of hair, temperature changes such as cool and clammy or warm. The area is extremely sensitive to touch, changes in temperature, etc... and the limb is kept immobile by the patient as to avoid any stimulation whatsoever. It is unusual for the pain to be in a major joint such as the knee as there is constant movement and flexibility there that would render even very mild bending almost unbearable by the patient. That's not to say it's impossible for you to have this syndrome, but I would want to make sure that there's nothing orthopedic that;s causing this, which is what your symptoms sound like.
Complex regional pain syndrome or reflex sympathetic dystrophy is a burning/nerve type pain syndrome resulting from some kind of trauma like a minor injury or surgery. It is usually associated with autonomic features which means there are skin changes in the affected area, smooth and shiny, loss of hair, temperature changes such as cool and clammy or warm. The area is extremely sensitive to touch, changes in temperature, etc... and the limb is kept immobile by the patient as to avoid any stimulation whatsoever. It is unusual for the pain to be in a major joint such as the knee as there is constant movement and flexibility there that would render even very mild bending almost unbearable by the patient. That's not to say it's impossible for you to have this syndrome, but I would want to make sure that there's nothing orthopedic that;s causing this, which is what your symptoms sound like.
The knee injury that you had originally was trying to tell you that you should stop doing what hurts.
Running, doing deep knee bends with additional weight, using the stair machine set to higher than 8 inches can overflex the knee and put pressure on the patella. Nature was warning you to
stop the activity and you continued through the pain.
Surgery may have been needed to reattach a ligament, but the continued use of the causative exercise risks further damage.
Right now, the cartilage behind the patella is likely damaged or missing and osteo arthritis can be rearing its' ugly head.
Check out these links and I wish you luck...
Ron
http://www.drmirkin.com/archive/6538.html
http://www.drmirkin.com/archive/6722.html
http://www.drmirkin.com/fitness/9902.html
http://www.drmirkin.com/archive/6170.html
http://www.drmirkin.com/joints/9238.html
http://www.drmirkin.com/fitness/8022.htm
http://www.drmirkin.com/fitness/7855.htm