Tenosynovitis with arthritic changes

[Teddybear556]

Docs found on my ankle MRI 1) Marked subcutaneous edema of the distal lower leg and ankle. 2) fluid present within the flexor hallucis longus tendon sheath.  The fluid extends along the plantar surface of the tendon as it progresses towards the insertion of the hallux.  3)  Degenerative changes within the hindfoot.  4) Subchondral cyst is present as well as adjacent cyst within the sustentaculum tali at the level of the medial subtalar joint.   Diagnosis: Tenosynovitis of flexor hallucis longus.

Thankfully I have Distal Polyneuropathy (a genetic disorder) in my right foot I do not feel all the pain I should be feeling. I have been told this condition is horribly painful. Now my knee on the other hand is a 13 on the pain scale of 1-10. In August I had a Cortisone shot in my right knee but it only lasted 2 weeks then the pain came back worse.  Since I had to have 2 neck surgeries one in Sept. and 1 in Jan. I couldn't go back for another shot.  My first knee replacement was in 1994, 2007 it was removed and replacement.

They tried to MRI my knee but could not see through my metal due to the total knee replacement. Since I have a very low platelet count and on Warfarin I am only allowed to be an anti-inflammatory for 14 days no longer. I start this tomorrow to buy me some time to get into the ortho surgeons office. I don't know what will happen next.

Can anyone tell me what is in store?  I am not a dancer or runner or for that matter on my feet all day, this problem I have seen doctors for 1 1/2 yrs before finding a diagnosis.  I read the normal course of treatment is 6 months of anti-inflammatory.  But 2 weeks is all I am allowed.

[S. Kaul, MD]

Hi there!

I would assume you to be talking about the knee with the replacement. Well, without a clinical evaluation it would be difficult to determine the cause of the pain. Possibilities that may need to be considered include hardware/ prosthesis issues, degeneration, injuries, inflammation etc. MRI’s are not typically recommended with metal implants due to lack of image clarity. A CT or an MRI with adjusted pulse sequences and other parameters are more acceptable options. With bleeding/ platelet issues NSAIDS are typically avoided since they tend to have anti-platelet action with cumulative doses. However, a few other medications with little or no anti-platelet action such as steroids may be suitable in such situations. It would be best to discuss alternative anti-inflammatory medications and possible causes with your treating doctor for appropriate management.
Hope this helps.

Take care!

[Teddybear556]

Hi Dr Kaul,

Thank you for replying.  The arthritic changes actually have taken place in my ankle.   I did go see my ortho doc yesterday and he said he could not address the ankle I need to go see an orthopaedic.

He examined both my knees - right knee is the replaced one, he said I had an inflamed tendon in front of my knee I believe he used the word Patella Tendon.  The left knee same there but I also had a bursa.  He gave me an cortisone injection in both and I am to go back in a week to see what is happening.

The thing is I am not a runner, dancer, gymnast just an ordinary person somewhat limited due to a neck fusion from C3-T1.  So I am not sure what is causing all my tendons to be inflamed.  What causes this, any clues or can you point me into the right direction?  Thanks for your help.