Femoral Nerve Block

[karen.hankey]

I have a 51 year old lady who fell over a coffee table (can't remeber how she landed) in Sept '05. She only had pain at night at that stage. However 1 month later noticed a large lump was present on the medial aspect of her knee. So she saw her GP, had an X-Ray and was told it was a meniscal tear. Saw a consultant in Nov '05, had an MRI and was told it was a meniscal cyst and also had 'a hole at the back of the kneecap'

She underwent arthroscopic surgery in Jan '06 where a femoral nerve block was used to have a debridment. All went well, started physio and progressed well but only upto a point, at which stage a cortisone injection was given to help the physio along.

Consultant not happy with progress so another MRI scan showed that the cyst had enlarged again and so this time she had open surgery to remove the cyst. A complication arose in that the cyst was wrapped around the MCL, so this was detached to remove the cyst and then reattached. The patient was then put in plaster originally and then a full leg brace until Oct '06.

Since then she has been attending the gym 5 days out of 7 doing bike, walking on an incline, rower, arm weights and her physio exercises. She also walks her dog 3 times per week.

She struggles to walk up slopes, problems up and down stairs, in wet weather and when not in trainers. She also cannot kneel on it.

Her leg gives way approx once per week (improved from the 3-4 times a week it used to). It also locks when in certain positions.

She can't SLR or actively knee extend. She has little tone of her leg. Hams strength is not too bad.

She is having 3 hours a day of Trophic Electrical Stimulation to try and help the nerve pathways. She had baseline measurements 2 months ago and is back there today for further measurements, so not sure if its working yet.

Can anybody please advise on the next step for this patient and shed any light on if the femoral nerve block has had an impact.