Advice needed RE:Knee Injury

[SAMMY650]

Hi all,

Not sure if I've posted this in the right place but here it goes....

Long story short i was knocked off my push bike by a car which caused alot of damage to my right knee (that was in 2000)

After 4 lots of key hole surgery, one bone graft from my hip and then finally a femoral wedge osteotomy in which they put metal work in the leg to try and relieve pressure on damaged area of knee I'm now looking at the prospect of having knee replacement sooner rather than later (I'm only 25!!)

I have been taking Tramadol for over 3 years and it now has very little effect on stopping the pain in my leg.
I went to see my Dr today and he has told me to consider Steroid Injections into the joint to stop the pain. Has anyone had this done before? If so, does it work? Is it worth it?

My main concern is that if it does take away the pain am I likely to 'overuse' the knee and end up causing more damage?

Any advice on the injections or suggestions on other methods of stopping the pain would be very very much appreciated as it's making me miserable as it hurts all the time, (especially when im out on the bike and need to use the rear brake!) :(:(:(


Many Thanks in advance all.

[anna]

I´m afraid I dont know anything about knee injuries however the "wonky knee gang" members should be able to help..

Rictus or K are much more likely to be able to offer real help to you.

[rictus01]

I can understand where you're coming from as daily knee pain is a part of my life as well.

As they bothered to do the wedge osteotomy , it shows you at least have some ligament support there, which is better than not having it, so you should get perhaps 10 years before needing a replacement (subject to use obviously).

As far as the Steroid Injections are concerned,yes they do work, but they aren't painkillers, so not a replacement for tramadol.

you'll probably be offered cortisone (the steriod), which is an anti-inflammation, so it does work, but by reducing the inflamation , not killing the pain. I've had it in the past to good effect with sports injuries, how ever it depends on where the pain is coming from.

if it's imflamation, then you will get some benefit although it's designed to reduce it while healing from injury, in your case if you have a perminant cause then the inflamation will come back, so it'll be an on-going treatment ( depending on how long it's effects last) perhaps weekly or if better monthly.

If however; like me you have no cartilage left in the joint (basically the bones bounce together causing the pain) then although the symptoms are much the same and it feels like inflamation (as in after any effort the knee becomes very painful) there is no actual inflamation, so nothing for the Steroids to work on.

I wouldn't worry about "over use" whilst on the steroids as it will still cause pain should you push to hard, so in conclusion I'd say give it a go, if it works it'll make living with it more comfortable, if not you'll just have had a little discomfort for the injection.

Hope that helps.

Cheers Mark.

[shonadoll]

I had a cruciate repair, and had steroid injections afterwards, which I found painful and as I found out later are contra-indicated where ligament grafting has been done. I was on tramadol 50mgs, but am now on 200mgs SR which is the slow release version, which I find much better at pain control.

The steroid injections nip when they go in, and it's not pleasant but did offer a slight improvement for me.

[shonadoll]

On the pain relief angle, I was in constant pain before they sorted my tramadol out, and kept going on about it till they referred me to a pain management guy. I had a back surgery a few years back, and am left in pain from that. I don't get why doctors seem so resistant to proper pain management- the guy I saw said it's really common, but basically he just changed and upped my drugs very slightly, and changed a nighttime one and it's made a big difference.

Chronic pain is not something you should have to live with, in my opinion-it's miserable, and has made me very depressed more than once, and it affects every area of your life, so don't let em fob you off.

[SAMMY650]

Many thanks for the replies. So the injections are aimed more at inflammation than actual pain itself? I just want to confirm that before i go ahead with it as the doctor already confirmed there isnt much inflammation around the injured area and thinks the pain is coming from the bone itself (if that makes sense?)
Bascially, when the car hit my leg it split my shin bone down the middle (about 3-4 inches) and caused one side of the top of the bone to be about an inch lower than the other.

(The top right of my shin looks like shattered glass in the last x-ray i had)

I do the basics like cold packs, elevation and physio exercises.

Should i give the injection a miss do you think?

[dawn07]

Personally, I would give the steroid injections a go. Individual response varies. Meantime you have to get your analgesia reviewed by your GP and a referral to the 'pain management clinic' at your local hospital.
Have you tried all the alternative therapies? Have you tried 'glucosamine' , etc?

[rictus01]

yeah my case was a shattered head to the tib & fib and a split up the femur, so it's bone pain, Steroids wouldn't work for me as I have nothing left between the bones.

whilst it's doubtful (if it's bone pain) the injections will have much effect, your doctor obviously thinks it worth a go, seeing as how you do still have something there to inflame it may well be of benefit, whilst uncomfortable it's not greatly painful, so I don't see any harm in trying, but if you're still concerned ask him about it as Steroids only give secondary pain relief by reducing inflamation as said.

Cheers Mark.

[SAMMY650]

Thanks for the advice guys, seems like it'll be worth a go even if it only takes the edge off the pain.

[shonadoll]

As Dawn said, glucosamine. I work in a vets and it's been used to great effect with dogs-some coming off powerful antipain meds, and also used in humans to great effect. I'm a convert-get the kind with chondroitin in.

[Nick762]

I started getting discomfort in my right knee about 2 years ago and put it down to the fact I was cycling 16 miles a day. It didn't really disappear when I gave cycling a break and eventually I saw my GP who referred me to a joint specialist who gave me an MRI scan. Cut a long story short I have a touch of early osteoarthritis (at 46 :( ) which has effectively ruled out running any more.

The specialist recommended Glucosamine and Chondritin (spelling?) but said make sure I get the high dose (think horse tablets) ones i.e 1500mg. They are pricey but Boots do a three for one deal on "Glucosamex plus". Works out about 60 quid for three months supply. I can't swear to it but the discomfort has reduced. I can walk a fair distance with the baby carrier on my back although I have invested in a hiking pole.

Rose hip apparently has also been found to be of some benefit in recent studies... it is supposed to encourage cartilage growth.

[rictus01]

As far as I'm aware glucosamine acts to thicken the joint fluid and promote cartilage grouth and provided you have some should help, chondroitin does much the same thing for connective tissue (tendons & ligaments) so if they are recovering it'll likewise help.

However they will do nothing for major injury, so it very much depends on the severity you have.

Cheers Mark.

[shonadoll]

As far as I'm aware glucosamine acts to thicken the joint fluid and promote cartilage grouth and provided you have some should help, chondroitin does much the same thing for connective tissue (tendons & ligaments) so if they are recovering it'll likewise help.

However they will do nothing for major injury, so it very much depends on the severity you have.

Cheers Mark.

There's an excellent write up on it here


http://www.cocoonnutrition.org/catalog/page_glucosamine_sulfate.php

[rictus01]

Oh I've see just about all there is to on the subject, trust me everyday pain gives you an incentive, both of these supliment the bodies own repair/rebuild of ligaments/ cartilage and as said should there be anything left to repair then they will help.

But if the end of a bone has been shattered and rebuilt surgically and the cartilage is gone, it's not going to grow back, likewise it won't work on a replacement ligament either.

As I previously posted it's a case of degree I suppose.

Cheers Mark.

[hooters]

i have hasd the steriod injection in my hip n it wasnt as painful as be for all u can do is give it a go, i bloody hurts tho lol
i hope you get on ok

[dawn07]

I have patients who swear by Glucosamine and Devil's claw dx

[shonadoll]

Oh I've see just about all there is to on the subject, trust me everyday pain gives you an incentive, both of these supliment the bodies own repair/rebuild of ligaments/ cartilage and as said should there be anything left to repair then they will help.

But if the end of a bone has been shattered and rebuilt surgically and the cartilage is gone, it's not going to grow back, likewise it won't work on a replacement ligament either.

As I previously posted it's a case of degree I suppose.

Cheers Mark.

I think it's one of those things though-it is worth trying individually as it does no harm, just in case a slight degree of pain relief due to an improvement of ligament support to the area even makes the difference between coping and not coping with the pain. It's impossible to know without the individual trying.

I'm very aware of chronic pain and how debilitating it is-I have been offered morphine tablets twice so far as the next step in pain management, but hope to delay that as much as possible.

[SAMMY650]

Thanks everyone, well ,I'll be trying all ideas/advice put forward so far, even if something only just takes the edge off the pain it will be an improvement.

Many Thanks everyone

[shonadoll]

Thanks everyone, well ,I'll be trying all ideas/advice put forward so far, even if something only just takes the edge off the pain it will be an improvement.

Many Thanks everyone

Best o luck:D

[darylB]

Don't know if this will help but my other half (Bev) is a physio, she suggests trying acupuncture as she has had good results from traeting people with it. steroids are strong anti inflammatories and pain killers, but she say's to try a max of 2 injections at first, if no response after the 2nd then they are not effective and any more would be pointless. Also have you had physio, if not then ask for a referal, some physio's use accupuncture as a treatment.

Hope this helps.

Daryl.

[SAMMY650]

Don't know if this will help but my other half (Bev) is a physio, she suggests trying acupuncture as she has had good results from traeting people with it. steroids are strong anti inflammatories and pain killers, but she say's to try a max of 2 injections at first, if no response after the 2nd then they are not effective and any more would be pointless. Also have you had physio, if not then ask for a referal, some physio's use accupuncture as a treatment.

Hope this helps.

Daryl.

Thanks for the info Daryl (and Bev), I've been in and out of physio for years and have had acupuncture before but it didnt really help, cheers for the advice on the injections though I'm glad you've pointed out a max number to have to see if it works, i've got the first one booked in this week.

Thanks again

Sam

[Miss Alpinestarhero]

Interesting thread..

Ive had a really bad knee since I was 16. Not entirely sure why but it completly "went" about 2 weeks ago. I sat up and it just seized, I physically could not straighten it out because it felt like the ligaments inside/ nderneath my kneecap were twisted and were going to snap. My kneecap didn't dislocate but I had to somehow wiggle my kneecap until I could straighten my leg out.

The pain was nothing like I had ever experienced in my life, I was in absolute agony. and I still am hobbling around 2 weeks later...the GP refuses to do anything except recommend anti inflamatory cream.

Maybe a physio is the answer

[shonadoll]

Interesting thread..

Ive had a really bad knee since I was 16. Not entirely sure why but it completly "went" about 2 weeks ago. I sat up and it just seized, I physically could not straighten it out because it felt like the ligaments inside/ nderneath my kneecap were twisted and were going to snap. My kneecap didn't dislocate but I had to somehow wiggle my kneecap until I could straighten my leg out.

The pain was nothing like I had ever experienced in my life, I was in absolute agony. and I still am hobbling around 2 weeks later...the GP refuses to do anything except recommend anti inflamatory cream.

Maybe a physio is the answer

Go back and see your GP again- they are notorious for sending you away and waiting till you come the 2nd or 3 rd time. My GP was hesitant to refer me when my cruciate ligament snapped, and my knee kept collapsing, was in agony.

Go again and be insistent-being in agony is NOT normal.