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Thursday, April 24, 2014
After amputation tight tendon
My husband has been an amputee for 4 years now. (above knee, left leg) He has had a muscle or tendon that has been tightning ever since the surgery. He`s at a point now that he can`t take the pain anymore, and it seems to be effecting a nerve now that it hadn`t before. He gets "lightning bolt shocks" in the tip of his nub, so bad that it makes him sweat all over. what can I do to comfort him and are there any doctors who just specialize in post amputee patients?
Although you mentioned your husband has a muscle or tendon which has been tightening for the past 4 years, this would be a very unusual cause for progressively worsening pain symptoms following an amputation, since the ends of muscles/tendons are usually anchored by being sewn/attached - ideally to the residual bone itself, but alternatively, muscles/tendons on opposite sides of the residual bone are sewn to each other. If he has not already done so, he should follow-up with the surgeon who performed the amputation to see whether a tightening muscle or tendon is a possibility. Even if it was a possibility, this should not be causing progressively worsening pain over a 4 year period and would not be affecting a nerve - despite the "lightning bolt shock" sensations.
His pain symptoms sound "neuropathic" in nature, as could result from irritation of a neuroma - a bundle of nerve endings which always forms at the severed end of any nerve, but which may or may not become symptomatic (painful).
If your husband wears an above-knee prosthesis, pain which is worsened by wearing a prosthesis may benefit from prosthetic socket modification by his prosthetist. If your husband doesn't wear a prosthesis, sometimes wearing one will actually help pain symptoms, particularly phantom sensations (which your husband may or may not still be experiencing). If he doesn't wear a prosthesis and doesn't plan on doing so, attempting to treat his pain by further surgical intervention is usually a last resort, especially if the amputation was performed due to poor circulation, due to potential complications.
Therefore, nonsurgical treatments are usually tried, often in combination, and are often of significant benefit. These can include:
- desensitizing massage treatments - as can be guided by his Prosthetist - or a Physical Therapist with experience working with amputees,
- trial use of a TENS unit (transcutaneous electrical nerve stimulator) which is usually coordinated by a Physical Therapist,
- proper wrapping of his residual limb (sometimes called "stump"), and/or
- a number of medication options, as can be determined by either his primary care physician, or possibly a physician Pain Specialist.
Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University