Spasms in knee area

[Oma6]

I had a revision of a TKR on my left knee on January 14, 2008, replacing one that was done in 2005. About a month before the surgery, I ended up in ER with painful spasms in my knee. The area that would be covered by a knee brace is where the spasms are located. It feels like they are tightening that area with intermitten pain that varies from tolerable to absolute torture. They are constant and last from 2-5 hours, getting more painful as the time goes on. They have continued since the surgery and occur both during the day and at night.These spasm episodes occur usually once or twice a day. The ones at night are the worse, as the only way I can function is to get up and walk or stand. Laying down or sitting is very hard and almost impossible to do. My leg is very stiff while all this is going on and driving me nuts.
In the ER I was given a shot of Demerol and then Oxycontin and a muscle relaxant to use until I saw my Dr. on Jan. 9th. After the surgery when I was having both surgical pain and the spasms, they called in the pain specialist who put me on a 12 hour extended release Oxycodone, Flexeral to be taken three times a day and to take Tylenol every four hours throughout the day and night if I am awake in the night. All of these meds don't seem to do a thing for the spasms except maybe take the edge off. I also have Restless Leg Syndrome for which I take 5mg Requip and Lyrica             three times a day. Until yesterday (1/26/08), I had no RLS at all, but it seems to be back around 4AM and last for a couple of hours. Today it went from RLS right into the spasms. I have talked to both my family MD and the PA at the Orthopedic office and they have no answers to the spasms, except the PA said that when I could get on a recumbant bike in a week or so, he thought they might go away. Does anyone have any ideas on how I can get some relief or does anyone have similiar spasms?
Thanks for your time- I hope someone can help.

[geezer13]

Hi - I also am having those horrible Knee Spasms that you had.  I put a heating pad on that knee (right knee) tonight.  Made it worse.  Took two aspirin.  Nothing.  Decided to Google Knee Spasms and ran across your notes.  I will try the ice and Tylenol.  Definitely can't get to sleep and am so tired.  The spasms come about 13 seconds or less apart so I can't lie down and go to sleep.  They last just a couple seconds each time or so.  I also have Restless Leg Syndrome and take one Miramax a day for that.  Crazy!    I'm an old geezer but in pretty good health (except for this new pain in the you know what).   Restless Donna

[JainMD]

Hi,
It's great and positive news regarding your improvement. I mean when you get to know that you have improved from last time around from the same doctor, it is indeed reassuring. Keep it up and go slow.
I would recommend if you have any pain or spasm while you are on physio to take anti-inflammatory medications.
You can start with low dose and increase the dosage as required.
Keep me informed if you have any queries.
Bye.

[Oma6]

Hi,
My first PT was great. I am seeing the same PT has I had when my knee was first replaced two years ago and he was amazed at the range of motion that I already have in comparison to the first time around. I will be doing PT three times a week and I am trying to rest both my leg and myself, by still applying ice at least two times a day for a couple hours each time. Again thanks. I will keep you posted.
Linda

[JainMD]

Hi Linda,
It is nice and re-assuring that our comments is being listened.
I am happy that you are back on the path of recovery. It will take time for complete recovery as age is not by your side.
Do not exert your self on physiotherapy. Keep doing slow physiotherapy and smaller repetition initially and gradually as it is tolerated you can increase the range of exercises and also increase the repetition.
Usually most of us after feeling little better try to get on very fast with physiotherapy, but this proves to be harmful in long run.
Get well soon and praying for your faster recovery.
Bye.

[Oma6]

My name is Linda and I will be 65 next month. I have never smoked. Today is three weeks since the surgery and I will be starting out-patient PT today. Things have been going very well. I am now only using Tylenol spaced throughout the day. I am applying ice three times a day for a couple hours each time. I really am trying to rest and not push it but that is very hard for me. The spasms have not occured for the last two days and before that they were certainly lessened in both intensity and in the length of time the occured. I really appreciate your answers, I feel like a new person. Lets hope things continue the way they have been going.  Again thanks so much.

[JainMD]

Hi Oma,
What is your name? How old are you?
You should be taking these above mentioned analgesic regularly. Make sure that these analgesics are spaced out evenly over period 24 hours in a day. You should not be taking 2 different analgesics at the same time.
Give yourself enough rest before you start on to move around.
Do not exert yourself.
Are you a smoker?
Keep me informed if you have any queries.
Bye.

[Oma6]

Thank you.I have been applying ice with my ice machine for several hours a day. Usually for a couple of hours 3or 4 times a day for the last two days and I have had no spasms, so hopefully that will do the trick for now. They tried Soma when I was in the hospital, but that did not seem to work well for me. As for the meds I am on now: I take Extended release Oxycodone twice a day with two Tylenol every four hours throughout the day and Flexerol three times a day. I really appreciate all the help and after two days and two nights without  spasms, I am keeping my fingers crossed.

[KellyA74]

Soma seems to work well for spasms.....

[JainMD]

Hi,
I think this should help.
You should be giving rest to the part, apply ice to the part i.e. do cryotherapy, take help of NSAIDs like acetaminophen, Ibuprofen etc , apply lidocaine patch, and/or a steroid and anesthetic injection will be helpful.
What kind of pain-killers are you on?
Keep me informed if you have any queries.
Bye.

[Oma6]

Thank you so much for answering my questions. I will speak to my surgeon regarding these spasms. I had intended to do that on Friday, but he was out of the office and I only saw his P.A. In the meantime, do you have any suggestions for relief? Thanks

[JainMD]

Hi,
I think your symptoms are due to nerve compression at the level of knee brace. I think you should be seeing your surgeon back and decide regarding further management.
It could be due Restless Leg Syndrome, but there appears to be some neuropathic pain which wakes you up from sleep.
I think your symptoms might be also being due to Tarsal Tunnel syndrome due to nerve compression.
I think you should be seeing your surgeon back and discuss regarding these symptoms.
You can also get imaging study done which should be MRI to understand the anatomy of soft tissue surrounding the knee.
Keep me informed if you have any queries.
Bye.