Question
QUESTION: I had Arthroscopic ankle sugery and a Brostrum repair over a year ago. I had fractured it, torn ligaments, and tendon damage.

What happened was I was practicing soccer and I accidently kicked the ball over the fence and then climbed the 5 foot fence (a little over my height), and then twisted my body around to avoid my neighbor's garden and landed awkwardly in a hole. I fell and heard a huge pop. My ankle never healed as I had fractured it, also torn ligaments and tendon damage. This is why I needed surgery because it never healed properly. I have gone to physical therapy and helped alot. My ankle surgery was April 2008; The last therapy session was in October 2008; and I was fine until a month ago (June 2009) where I started feeling the pain again.

I called my doctor regarding my concern with the cortisone injection and all he did was prescribe me prescription pain pills; this was last week. I don't know why he didn't want to see me. But now I would have to call him back as those pills didn't work and gave me bad headaches. I would tell him that I am still having complications with the cortisone injection and hopefully he will then see me.

However, it has been three weeks and the injection is still painful. Also, I am noticing that the injection site is dark colored with bruising around it and bruising to the right of it. It does feel warm to the touch on the area where it is bruised. I also have a small bump to the right of the injection site. Do you know what this could be?

Is this normal to be having complications three weeks after the cortisone injection?  is it normal to still be having pain over a year after surgery?

Any thoughts would be greatly appreciated. Thank you.

Cassie




ANSWER: Didn't mention what kind of surgery was done
Sounds like you may need a repeat xray and maybe a CAT scan to rule out any damage to the talus(ankle bone). After fractures of joints it is not unusual to have arthritis of the joint. The pain may resolve with physical therapy, but usually returns. Residual arthritis may also respond to additional physical therapy and bracing.  You need a second opinion--especially if he is giving you pain pills and not a diagnosis.
It is normal to have bruising and local discomfort up to three weeks after any kind of injection.
Sometimes
Hope This Helps

Dr George Tsatsos

This is not medical advice and for informational purposes only

---------- FOLLOW-UP ----------

QUESTION: Thank you for replying.  I did mention the kind of surgery.  Arthroscopic surgery and a Brostrum repair.  I also had physical therapy after surgery for is months.

My question is though I is there a small bump near the injection site?

Cassie

Answer
Sorry--I did read about the surgery-It was late when I was replying
OK here goes--
Bronstrum repairs are tricky and sometimes in the repair the tendon gets tightened too much-or has some nondisolvable suture that gets caught in the ankle joint. I have had to to a few revisions with these problems.
These problems do not resolve with an injection.
The only fracture repair that you can do with a scope in the ankle is limited to mostly cartilage defects. Lately there has been a movement away from scoping of the knees and ankles due to studies showing recurrence of the problem that the scope was originally used for.
More doctors are using more of smaller incisions -but direct visualization of these problems.
Needless to say that there are docs out there that are great with scopes! I scope for some procedures-but prefer direct visualization.We plan the scar to be small and not problematic.
Again sounds like you need a Cat Scan or MRI if there is no metal in the ankle.
The injection probably hit a blood vessel-known complication.
Sometimes certain cortisones cause a local tissue reaction of redness or a bump
It's not about the doc-it's about you----remember it's an art as much of a science.
Get a second opinion on both
Good Luck
Dr George Tsatsos

Not advice-Just information