knee and quad

hi there

im 46, my quads were fine before surgery... i used to go running, play squash and did a physically demanding job as cabin crew. i had a bkers cyst and probable meniscal tear so underwent knee arthroscopy nov 2012 , under gen anaesthetic.  as soon as i went for stitches out and dressing to be renoved about 10 days after op, th ephysio noted poor quad control. i was unable to lift my leg at all to do a straight leg raise. i was sent for physio, no improvement!!! many emgs, mris etc later...still nothing definitive found. leg keeps giving way, and as a result i fell a year ago and ended up with a fractured (stellate) patella baja. was put in a brace in july last year and have been in one ever since. i have seen physios, acupunturists, chiropracters, hypnotherapists etc. i have thrown all the monety at it i could and still have this quad atrophy!!! i lost my job on medical grounds and continue to see consultants etc who say there is no sensory problembut there is a motor problem. i have no reflex now in my right knee...... and it goes on....and they cannot figure out how/why this has happened!!! 

Ouch! The quad can waste quickly after knee scopes or injury. Did you have pain or swelling after surgery? Did they rec. quad strengthening immediately after surgery?

Do you have knee pain now with the weak quad? 

I struggled with this too. PT's were useless-made it worse. All the education but they have no experience.  

I can tell you that getting the quad back is difficult. My alignment was/is bad making it 100x worse to target. Finally on my own I decided I had to do leg extensions which hardly anyone rec's. This was painful, even starting with 10 lbs.  I worked my way up. Then I graduated to machine hack squats. Again very difficult, but I am working my way up. I started hitting the quad again early November. I still have a long way to go. Sometimes I had to leave the gym because the pain wa too much- you cannot push through it everytime. Sometimes I was able to do side-lying leg lifts to ease the pain on the kneecap, and proceed to doing the lifts. I myself fell around three times in the last year- luckily on my behind everytime- quad gave out instantly.

I would struggle with giving advice since you have patella baja now. I do not now how you feel with that and exercise. I can only tell you my story in short and what is working. I went against the grain because the alternatives were not working. 3 PT's, 2 orthos, 1 massage therapist, + chiro. 

I am still working on it but making monthly progress- note monthly, and slow. 

Are there any exercises you can do for your quad? Is the reflex thing permanent and how does that affect your rehab?  

I never had surgery but what is believed to be an overuse and muscle imbalance which in the end is probably worse than almost any knee injury if it gets back. It has been worse than hell.

hi again

thats the weird thing, had no pain whatsoever aft the surgery, the only problem i had was not being able to do a SLR , no quad control and knee kept giving way. but no pain unti i fractured it. i di have physio right after surgery but straightaway there was no power in my quad and nothing to work with. this is still the problem, i cant do any exercises for my quad, its not due to pain etc, its just that its impossible to raise my leg s i cannot do any exercises to start with as its just not firing/working at all.

there doest seem to be any exercise i can do for the quad as i just physically cant move it. cant believe all the specialists are just scratching their heads and acting like its a mystery

i wish you well in your recovery, sounds a nightmare as well

Hard to believe there is no pain in the knee from this- the quad is a major shock absorber. Something has to be firing. Can you walk? How (muscles used) do you walk or do steps? Or course everyone is different it seems. I get knee pain in several different spots. Last MRI clean. Could they have cut a nerve by chance? I would think you would have more symptoms of that though. 

i get a burning sensation in the knee a lot, the nightime is worse. i can walk as i am in a brace and crutches and the consultants say i am not using my quad when i walk, it seems im now hip hitching and using all different muscles in all the wrong ways to compensate. its weird...its like a paralysis of the quad, consultants are saying it could be a nerve palsy but they do not know how it could have happened as the op was routine; the nerve conduction studies showed ther was no activity in the right quad. its all so confusing!!!!!last mri in july last year showed fractured patella baja and some oedema and right quad atrophy.thet seem to think it is a problem with the motor part of the femoral nerve, the sensory part is fine. but who knows?????

Time to see a specialist unrelated to your case. Nothing is really "routine" when it comes to surgery. That is why I balked the last time my ortho asked if I wanted one. Then I showed him my one-leg squat before he left the room and he said my quad is weak and it was "painfully obvious" as to the cause. Knees are frustrating. There always seems to be 6+ different things that can cause the pain, beside it just being muscular at times. Did they just do surgery because they "suspected" a meniscus tear? A cyst is no reason to cut into you.

With all the info. you have now given, you need to see someone that can explore the nerve route. Even when my vmo was wasted, I could still barely lift my leg and my flexors would get sore really quick. 

Something went wrong with your scope in my opinion, based on what you have stated. This has gone on way too long...

yeah i agree...... and as a result of all this c...p i lost my job and ended up moving from london  back to wales where my parents are. the one thing i know is that i was able to do my job, drive etc before my op....

i have seen 2 neurologists who said it was a nerve palsy and sent me back to orthoepedics, who sent me back to neurology etc etc. i have a solicitor looking at everything but they said in order to claim medical negligence, it has to be proven that the op went wrong etc, and the theatre notes said it was routine and the tourniquet was on for time and pressure within all the guidelines.

i just cannot nderstand how i have no quad control and cannoy move it in the slightest, not even a muscle twitch. atfirst, after the op they said muscle inhibition was common and after physio and time, it would come back.....but it never did!!!!

i agree with you, i think something went wrong with the scope but i cannot prove it and they all seem mystified..im so very cross!!!!

Would MRI show if they cut the nerve? You need a proper diagnosis and game plan to recover from this. The muscle is not receiving proper signals so it has to be dealt with head on. I do not know how things work across the pond but maybe an attorney can advise you. The main thing it to get healthy.

unsure bout what mri shows.as im sure you know, you tend to get fed up with all the constant backing and forthing!!! its amazing how we take everyday activites etc for granted and then when something like this happens it changes your outlook. my friend actually showed me a great piece of writing done by an american lady, called the spoon theory. lookmit up if you get chance, its very true and thought provoking.

anyway, enogh of my moaning.off to bed now as 10.30pm here. thanks for your support and advice.

I'lll look that up- keep us posted on your outcome. All we can do is keep fighting and hoping for the best. All the best!

hi there, thanks for your interest and i think you are right that it is some kind of nerve damage. i wish you well in your recovery

So you are saying there was no pain until the nerve block wore off? Where is all the pain now and how are you managing/rehabbing? Curious...

Yes, no pain (well, very little) and I was able to bend that knee all the way to 127, but each day the pain increased and the amount of bend decreased, until now (6 days later) I have severe pain and can only get to 110 under extreme duress. The pain is in the quad muscle. It feels like the worst muscle pull you can imagine and because the quad is so painful, I can't bend the knee. Today I stated taking Aleve along with the oxycodone in the hopes that an anti-inflammatory would ease that muscle. Before the MUA the pain was not in that muscle so obviously the muscle did get pulled too much during that procedure.

I mentioned you to my therapist today and he said that a non-responsive quad could also be caused by back problems, but most likely the nerve was damaged during the surgery. His last cheerful thought was that the only thing you could be sure of getting with surgery, is a scar.

thanks so much for that info. i had my back investigated, chiropractersetc and they found nothing wrong with my back.....so the nerve damage is sounding quite likely!!!! hahaha, his comment mademe laugh,  how very true!!!!!