I have suffered from the anterior subluxation of the proximal fibular head for 7 months now, but no one in my area has ever dealt with this issue. The ATC that I studied under used to cut felt tape into a "Horseshoe" shape and place it around the Fibular head, as well as tape the distal end using Mulligan's Taping technique for distal fibular head hypermobility.
Can anyone help me fill in the blanks as to the exact placement of the horseshoe in relation to the subluxation? From the same fall, I had arthroscopic surgery results: Partial synovectomy lateral joint line, 3% lateral mesicus tear, articular cartilage tear and a floater.
I passed out, and the witness to my injury said that my knee hyperflexed and twisted inward and slammed against the floor. When they turned me over in the tight space where I had passed out, the witness said my knee wrenched back the other way.
I found out the rest of the taping technique from the ATC I studied under, but I now believe there's something else going on causing the tib-fib joint pain. Since the accident, I've had some pronounced snapping over that joint that sometimes offers relief. That pain along with the lateral knee symptoms had been explained away as the lateral meniscus tear and synovitis. (And easily so.) Since the surgery, the pain "subsided" but never has gone away. I started recieving synvisc shots and the lateral knee pain in the tib-fib area has soared beyond measure. The pain usually escalates within 36 hours of the injection and has stayed for over a week. Relief came from accupuncture from a PT and movement in the tib-fib region with an activator.
I've had it taped 2 times by different PT personnel. The first time following Mulligan's MWM, some relief followed. Yesterday, the tape job following Mulligan's MWM escalated the pain. The second time the snapping increased and the pain escalated, which sent me seeking some more. Further research has brought in the "possibility" of involvement of the biceps femoris tendon. Another rare possibility, but the symptoms are very similar.
I am seeking clues to bring back to my orthopedic who is stumped. If anyone has any tips or suggestions, I'm listening...in PAIN...and highly discouraged as I am an avid outdoors woman whose been sidelined almost 8 months. Thanks
Joined: February 14, 2003
From: Madison WI USA
I think there can be a cyst that forms after such an event. Regardless, try using a chopat knee strap, or similar strap to hold it in place while you do things, perhaps even enough to allow exercise. Eventually, the tape will beat up your skin enough to require you to stop using it. Make sure you do this with guidance from your current PT, as you dont want to pinch the neural tissues around the fibular head by strapping it too tight.
I forgot to answer part of your question of what brings on the pain. It's all regarding my left tib-fib joint.
It's definitely variable in some ways. Sometimes I find relief in a certain position but it may not last. Sometimes a hinged brace feels good, and at others it feels like an adversary. If I lay on my opposing side while sleeping, I always wake up in the middle of the night in agony. the most comfortable way to sleep is on my stomach with a pillow under my feet and lower leg. If I turn too quickly when walking, I hurt. If I sit and allow my foot to "relax" and pull on the tib-fib joint, it's painful. Bicycling hurts. Skiing hurts. Cross-country skiing felt "okay" until the series of "synvisc shots". My pain escalated beyond measure within 36 hours of each shot. At times, I felt like my lower compartment was going to explode. I can't "squat" down.
Joined: December 3, 2007
From: MI, USA (dreaming of New Zealand)
I have a pt right now who had a proximal tib/fib fusion, he had cysts like Steve mentioned so they took out the synovium and fused the joint. I don't think this is a very common procedure because he had to travel to an Ohio State (BOO!!!) doc to have it done because his first Orthopedic surgeon said he had never done this before.
So I have no idea if you are a candidate, but if the joint is truly unstable and still giving you the level of pain and difficulty after 7 months that you describe I might ask about it or look for another opinion.
"I have never let my schooling interfere with my education." Mark Twain
Joined: February 14, 2003
From: Madison WI USA
Prolotherapy is not a bad idea, as it is supposed to sclerose the ligaments a bit. However, I had it once, and given the proximity of the neural tissues around the proximal fib head, I would make darn sure that you get someone who has done it there before, multiple times. I had it on a shoulder, and at the time my doc was a newbie with it, and he hit my radial nerve. No residual problems, but nevertheless it wasnt too enjoyable.
After three rounds of prolotherapy, the fibular head has stayed secure for almost 3 months!!! I am soooo thrilled with the procedure that was painful, but worth it after a year of total pain. Prolotherapy sure was better than surgery to fuse the bone at the proximal and distal end as recommended by 2 different OS.
I am back to biking 16-20 miles a day, and walking. I am still recouping from the side-effects of Synvisc but I've come a long way after chelation and prolozone therapy as well. I am so thankful for all of these treatmentst that have given me my life back.