Knee and Leg Pain from PN Surgery?

[John]

I've been off the site for a while. I had bilateral decompression surgery with Dr. Ansell 5 years ago. The pain was worse after surgery, but I'm managed to have a semi-normal life with pain medication. Now I've developed knee and calf pain. Doctor's can't find anything wrong with my knee. Had and EMG & lumbar MRI, came back normal. It seems to get bad if I sit or stand. Has anyone developed knee or leg pain after surgery? Did you have any treatment that helped?

[nyt]

Depending on where your leg and knee pain is there could be at least two major suspects. Many individuals with PN even after surgery have pelvic floor dysfunction and piriformis syndrome. The piriformis muscle lies over top of the sciatic nerve and in some individuals the nerve actually splits in two and runs through the piriformis but the majority of us that is not the case. When the piriformis is in spasm or is just really tight it contracts around the sciatic nerve giving pain in the back of the leg, hip and down to the knee and sometimes even to the feet since the sciatic nerve branches just above the knee and innervates the knee. The other thing that can happen in the pelvic floor the obturator internus muscle becomes very tight. The obturator nerve runs through the obturator internus muscle so when that muscle spasms or is tight the adductor muscles on the inside of the legs get tight and painful. The obturator nerve runs to the inside of the knee. With sciatic pain most of the pain is in the back of the knee with obturator pain it is on the side of the knee but sometimes it can make the whole top of the knee ache.
Hope this helps.

[John]

Thanks NYT! I'll speak to my doctor about this.

[greentree]

If your surgery was 5 years ago and you developed this knee/calf pain only recently (?) the two things may not be related. I' not saying they are not, though.

In herniated disc in the lumbar spine, the pain is in the lower back, back of the buttocks, back of the thigh, behind the knee in calf or in foot. This pain is called sciatica. It can be only in the upper leg, in the entire leg, but less likely only in the lower leg. Pain in the lower leg would be likely accompanied with some tingling or numbness. The buttock or leg would not be especially tender to moderate pressure. Sciatica is typically aggravated by sitting and standing, but relieved by walking. Negative lumbar MRI does not reliably exclude herniated disc.
http://www.ehealthstar.com/conditions/b ... iated-disc

In piriformis syndrome, the pain can be similar that the one in herniated lumbar disc. The pain during sitting appears on the bottom of the buttocks rather than in the lower back and upper buttocks. The pain in the buttock is aggravated by walking. The bottom of the buttock would be tender to moderate pressure but the thigh and calf would not be. The pain can be only in the upper leg or in the entire leg, but less likely only in the calf.
http://www.drpribut.com/sports/piriformis.html

There's one simple and well known test for sciatic pain: straight leg raise. You lie on the back and someone slowly raises your leg (with pain). In herniated disc or piriformis syndrome, at some point of leg elevation, you would very likely feel pain in the leg. If the pain originates in the knee, this test would not cause pain.

You did not say in which part of the knee is your pain and is it aggravated or relieved by walking. If your leg behind the knee or in the calf is tender to moderate pressure, it is more likely a local tendon/muscle problem.