[27F] Experiencing severe post-surgical leg pain and complications

Patient Description

A 27-year-old female is experiencing severe and constant pain in her right leg, which worsens at night and during rest. This pain originates from a previous car accident that resulted in a broken femur, subsequently treated with surgery involving the insertion of a rod and four pins. Despite completing physical therapy, the patient reports persistent weakness and unbearable pain from the hip to the toes, particularly from the knee down. The knee frequently dislocates during walking, contributing to a limp. The patient describes the pain as being located around the kneecap, down the shin bone, and into the ankle and toes, affecting the joints, bones, and tendons/ligaments. Additionally, there's noticeable swelling on the shin, varicose veins around the knee, and bruising without a clear cause. The pain is described as a dull ache during the day, escalating to sharp stabbing pain at night, leading to restless leg movements and sleep disturbances. The patient also reports occasional tightness in the chest, attributed to a history of anxiety, but has not considered a potential link to the leg pain. No recent fever, redness, or warmth in the affected leg has been noted, though there is occasional hip swelling and grinding due to the surgical pins.

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Arora's Assessment

What might be happening

Based on the information you've provided, the following conditions could be causing your symptoms:

  • Post-Thrombotic Syndrome (PTS): This is a condition that can occur after having a deep vein thrombosis (DVT), which is a blood clot in a deep vein. PTS can cause pain, swelling, and discoloration in the affected leg, as well as varicose veins. The pain often gets worse when you stand or walk for a long time, and gets better when you rest or elevate your leg.

  • Peripheral Artery Disease (PAD): This is a circulatory condition in which narrowed blood vessels reduce blood flow to your limbs. PAD can cause pain and numbness in your legs, and often causes pain when walking.

  • Complex Regional Pain Syndrome (CRPS): This is a form of chronic pain that usually affects an arm or a leg. CRPS typically develops after an injury, surgery, stroke or heart attack, but the pain is out of proportion to the severity of the initial injury.

  • Nerve damage or Neuropathy: This could be due to the surgery or the accident itself. Nerve damage can cause pain, numbness, and weakness in the affected area.

What you can do

You should definitely consult with a healthcare provider about your symptoms. They may recommend imaging tests, such as an X-ray, MRI, or ultrasound, to help determine the cause of your pain. They may also recommend blood tests to check for conditions such as DVT or PAD.

In the meantime, you may find some relief from your symptoms by:

  1. Elevating your leg when you're resting
  2. Applying a warm or cold compress to the painful area
  3. Taking over-the-counter pain relievers, such as ibuprofen or acetaminophen, as directed
  4. Wearing compression stockings, which can help reduce swelling and improve blood flow

What you should look out for

You should seek immediate medical attention if:

  • Your leg becomes very swollen or changes color
  • You have severe pain that isn't relieved by rest or over-the-counter pain relievers
  • You have signs of infection, such as redness, warmth, or fever
  • You have chest pain or shortness of breath, which could be signs of a serious condition such as a blood clot in your lungs (pulmonary embolism)

Please remember that while I strive to provide accurate information, I'm not a doctor and this advice should not replace a consultation with a healthcare provider.

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7 mo ago

People Also Ask

What is Post-Thrombotic Syndrome (PTS) and how is it related to leg pain?

Post-Thrombotic Syndrome (PTS) is a condition that can occur after a deep vein thrombosis (DVT), which is a blood clot in a deep vein. It can cause pain, swelling, and discoloration in the affected leg, as well as varicose veins. The pain often worsens with standing or walking and improves with rest or leg elevation.

How does Peripheral Artery Disease (PAD) affect the legs and what are its symptoms?

Peripheral Artery Disease (PAD) is a circulatory condition where narrowed blood vessels reduce blood flow to the limbs. It can cause pain, numbness, and weakness in the legs, often leading to pain during walking. Symptoms may include leg cramps, changes in skin color, and sores that do not heal.

What is Complex Regional Pain Syndrome (CRPS) and how can it develop after an injury?

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that usually affects an arm or a leg, often developing after an injury, surgery, stroke, or heart attack. The pain is typically out of proportion to the severity of the initial injury and can include symptoms like swelling, changes in skin temperature, and sensitivity to touch.

What are the signs of nerve damage or neuropathy following surgery or an accident?

Nerve damage or neuropathy can occur due to surgery or an accident, leading to symptoms such as pain, numbness, tingling, and weakness in the affected area. It may result from direct injury to the nerves or from complications like inflammation or compression of the nerves.

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1 Comments

Leo#3962

7 mo ago

I think you definitely want to get in touch with your surgeon ASAP. It sounds there may be some damage to the blood vessels and some nerve irritation or damage at the site of the surgery. I assume that if you've completed PT that your surgery was a while ago so this is definitely unusual. The surgery team should not be annoyed, it is there responsibility to follow-up on your healing and address any complications.

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