Managing Nerve Pain After ACL Surgery and Compartment Syndrome

Neuropathic pain in the foot and toes caused by compartment syndrome following posterior cruciate ligament surgery?

Hello Doctor, I had a bicycle accident 5 weeks ago, resulting in a fracture of the posterior cruciate ligament in my left knee, for which I underwent reduction surgery.
Subsequently, a vascular rupture was discovered, leading to another vascular reconstruction surgery.
Three days post-surgery, I experienced significant swelling in my left lower limb (compartment syndrome), necessitating an emergency fasciotomy.
Two weeks after the fasciotomy, I underwent a skin graft procedure to close the wound.

I would like to inquire about my condition.
Initially, during the first week post-surgery, I experienced persistent swelling and numbness in the sole of my left foot.
Since then, I have been suffering from nerve pain and numbness in my left heel and toes.
The orthopedic specialist informed me that the swelling from compartment syndrome has compressed the nerves, and that nerve recovery can take 3 to 6 months.
Until last week, before being discharged, I was relying on morphine for pain relief (administered every 4 hours).
Now that I am at home, I find the pain unbearable.

The orthopedic doctor prescribed me pain medications including ULTRACET, Tylenol, and Lyrica capsules.
However, the pain became so severe that I could not sleep at all, prompting me to consult a pain specialist who prescribed Cataflam and a pain relief patch (which had no effect).
Additionally, I was given stronger sedatives to help with sleep.
Unfortunately, these attempts have not improved my situation, and I am on the verge of breaking down due to the constant pain and inability to sleep.
I would like to ask for your advice on possible treatment options for my condition.
Would consulting a neurologist be beneficial? Or should I continue to try stronger pain medications? I am committed to rehabilitation over the next few months in hopes of alleviating the pain in the future.
If you have any other methods or suggestions, I would greatly appreciate your guidance.
Thank you!

Siro, 20~29 year old female. Ask Date: 2016/06/16

Dr. Gao Chunde reply Neurology

In principle, the neurology department is responsible for the standard treatment of your current neurological impairment.
If the physician chooses alternative treatment methods that still do not lead to improvement, you may be referred to a pain management specialist, which is typically available in larger hospitals.

Reply Date: 2016/06/16

More Info

Managing nerve pain after an ACL surgery, especially following complications like compartment syndrome, can be quite challenging. Your situation is complex, given the multiple surgeries and the subsequent nerve pain you are experiencing. Here’s a comprehensive approach to managing your nerve pain and improving your quality of life.

Understanding Your Condition
After an ACL reconstruction and subsequent complications such as compartment syndrome, it’s not uncommon to experience nerve pain. Compartment syndrome occurs when pressure builds up within a muscle compartment, leading to reduced blood flow and potential nerve damage. The symptoms you describe—persistent pain, numbness, and tingling in your foot and toes—are indicative of nerve involvement, likely due to the swelling and pressure from the compartment syndrome.

Recovery Timeline
As your orthopedic surgeon mentioned, nerve recovery can take anywhere from 3 to 6 months. However, this timeline can vary significantly based on individual factors such as the extent of nerve damage, overall health, and adherence to rehabilitation protocols.

Pain Management Strategies
1. Medication Adjustments:
- Opioids: While you have been using morphine, it’s essential to evaluate whether this is still necessary or if a tapering strategy could be implemented. Long-term opioid use can lead to dependency and may not be the best long-term solution.

- Neuropathic Pain Medications: Lyrica (pregabalin) is a good choice for nerve pain. If it’s not providing sufficient relief, discussing dosage adjustments with your physician may be beneficial. Other options include gabapentin or even tricyclic antidepressants like amitriptyline, which can help with nerve pain.

- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Cataflam (diclofenac) is an NSAID that can help reduce inflammation and pain. If it’s not effective, other NSAIDs or a combination of medications may be necessary.

2. Physical Therapy: Engaging in a structured physical therapy program can help improve mobility and reduce pain. A physical therapist can provide modalities such as electrical stimulation, ultrasound therapy, or manual therapy techniques that may alleviate nerve pain and improve function.

3. Alternative Therapies:
- Acupuncture: Some patients find relief from nerve pain through acupuncture, which may help stimulate nerve function and reduce pain perception.

- Transcutaneous Electrical Nerve Stimulation (TENS): This non-invasive method uses electrical impulses to relieve pain and can be a useful adjunct to your pain management regimen.

4. Psychological Support: Chronic pain can lead to anxiety and depression. Cognitive-behavioral therapy (CBT) or other forms of psychological support can help you cope with the emotional aspects of chronic pain.

5. Consulting Specialists:
- Pain Management Specialist: If your current pain management strategies are ineffective, a pain management specialist can offer advanced treatments such as nerve blocks or spinal cord stimulation.

- Neurologist: A consultation with a neurologist may provide insights into the nerve damage and recovery process. They can conduct further evaluations to assess nerve function and recommend additional treatments.

Rehabilitation and Lifestyle Modifications
- Gradual Increase in Activity: While it’s essential to rest, gradually increasing your activity level can help improve circulation and nerve function. Follow your physical therapist’s guidance on safe exercises.

- Healthy Diet and Hydration: Maintaining a balanced diet and staying hydrated can support your overall recovery and nerve health.

- Sleep Hygiene: Since pain is affecting your sleep, establishing a good sleep routine and discussing sleep aids with your doctor may help improve your rest.

Conclusion
Your journey to recovery from nerve pain after ACL surgery and compartment syndrome will require a multifaceted approach. It’s crucial to maintain open communication with your healthcare providers, regularly reassess your pain management strategies, and be proactive in your rehabilitation efforts. While the path may be challenging, with the right support and interventions, you can work towards alleviating your pain and improving your quality of life.

Similar Q&A

Post-ACL Surgery: Understanding Nerve Sensations and Recovery Tips

Hello: About three years ago, I underwent arthroscopic surgery for anterior cruciate ligament reconstruction in my right knee. Since then, I have been experiencing unusual sensations on the outer side of my right calf, such as tingling and numbness when I massage or press on it. ...

Dr. Hong Ximing reply Orthopedics
After undergoing knee joint surgery, many patients experience numbness in the skin on the outer side, which is likely a residual sensory symptom following the surgery. Symptoms can be improved through regular heat application and massage, or by consulting a specialist physician f...

Managing ACL Injuries and Complications: Recovery and Rehabilitation Insights

1. Several years ago, I suffered a torn anterior cruciate ligament (ACL) in my left knee during elementary school, which has occurred for the eighth time. My left side is strong, while my right side is weak and often lacks strength. How can I strengthen my quadriceps? 2. Recentl...

Dr. Li Wenhong reply Orthopedics
Hello: 1. If there are currently no acute symptoms such as swelling or pain in both knees, you can perform exercises such as straight leg raises, leg kicks, or partial to full squats. Please discuss the details with your physician after your consultation. 2. If symptoms are prese...

Post-ACL Reconstruction: Understanding Tightness and Pain During Recovery

I just had anterior cruciate ligament reconstruction surgery a week ago. During this week's rehabilitation, I haven't encountered any issues. However, starting yesterday, when I attempt to bend my knee, I feel a tightness and pain on the lateral side of my foot around t...

Dr. Chen Yongxue reply Orthopedics
After posterior cruciate ligament reconstruction, a brace should be used for protection and to assist mobility. In the early postoperative period, there may be discomfort during activities. If this discomfort is accompanied by new symptoms, please return for a follow-up appointme...

Managing Nerve Pain After Surgery: Tips for Better Sleep and Comfort

Two months after hemorrhoid surgery, I started experiencing pain in the groin area near the incision site, which only occurs when I lie down to sleep. The doctor mentioned that the scar tissue might be pressing on a nerve. Sometimes the pain feels sharp, and other times it feels ...

Dr. Jiang Junyi reply Neurology
Hello: You mentioned experiencing sharp or aching pain around the surgical site, which may initially suggest muscle tissue inflammation. If you are experiencing numbness or a tingling sensation, it may indicate nerve compression. A rehabilitation physician can arrange for a muscl...