Brief Answer:
Muscle fatigue can lead to vibratory sensation or fine fascicular tremors

Detailed Answer:
Good morning and many thanks for posing your question on Healthcaremagic.

Whenever someone mentions that they are having sensations of vibrations (internally) or a feeling of "shakiness" or quivering that is internally placed without being able to visibly see any muscle twitching or moving the first thing I think of is a NEUROPATHY (nerve malfunction).

Now, in your particular I believe there are a couple of possibilities to consider.

1. The vibratory sense you are having is in fact secondary to a NEUROPATHY which most of the time turns out to be something to do with a metabolic imbalance and this could also include hormonal imbalances in your body.

2. Muscle fatigue can also give a sense of vibratory or quivering internally when a person is fatigued or a muscle is exertionally pushed to a high limit that it is not used to doing.

Let's look at each of those a bit more closely.

1. NEUROPATHY of a metabolic nature. You state that "all blood work numbers good, sugar a little high"--- but you didn't specify which blood tests were good nor did you solidify the information on your sugar so that I could know for certain that you are either not suffering from a HYPERGLYCEMIC state (high sugar which could be transient) vs. a PREDIABETIC state...or even a DIABETIC state.

In order to clarify those issues here is what I suggest. First, find out when the blood draw was performed relative to when you last had anything to eat and drink. If the blood draw was any closer than 4 hrs. and you had just eaten something prior or had a meal then, the high blood sugar may be normal for that setting. I would ask that you get a FASTING BLOOD SUGAR. If there is a potential concern (as in this case that you could have a NEUROPATHY due to the vibrations you're feeling) then, I would also order a Hemoglobin A1C or HbA1C to see how your average glycemic status has been for the past 4-6 weeks. If this number turns out to be elevated then, your doctor will need to see you for some other testing because then, you may either be PREDIABETIC or DIABETIC. So in either of those 2 cases the vibratory sensation you're feeling could be a heralding sign of excessively high sugars which will need to be controlled.

If your testing for diabetes or prediabetes, etc turns out not to result in your having a problem and the elevation was only transient then, we've ruled that issue out.

Then, I would order the following bloodwork which is not always captured or done during routine draws after a procedure such as a meniscus repair:

A. serum Vit. B12
B. serum folate
C. serum Vit. D (total), D2, and D3
D. serum TSH, FT4
E. BUN/Creatinine/EGFR (Estimated Glomerular Filtration Rate)

These several labs are going to be the most common and important to look at when trying to resolve the question as to whether a metabolic neuropathy is afoot or not....make sense?

Now, let's be clear that in the case of Vit. B12 and Vit. D, many neurologists feel that "adequate" levels in the bloodstream in people with neurological issues (or in your case POTENTIAL neurological issues) differ from what the LAB NORMS state. Specifically, I like to see Vit. B12 levels in my patients of at least 400 if not 450 or greater in order to feel that we are not possibly running into a B12 deficiency situation responsible for the problem or symptoms. Vit. D also should be in the neighborhood of 60-80 (in my patients) as opposed to what many labs consider to be normal so long as results are >30...for me that is not enough Vitamin D firepower in the system to be sure that something like neuropathy couldn't be at least treated in part with higher doses.

The BUN/CREAT/EGFR lab values may already be in your bloodwork that you said was all good, except for the EGFR....that is not commonly asked for after an uncomplicated procedure UNLESS you have kidney dysfunction and somebody may be concerned about how your renal status might be following anesthesia administration or something. In this case, it's relevant because we're trying to identify a possible cause of the VIBRATORY sense and possibly calling it a NEUROPATHY.

So, let's say all that bloodwork is pristine, normal, normal, and nothing but normal.....well, then, young lady, I would agree with you that "all blood work numbers good." LOL.....NEXT

NUMBER 2- MUSCLE FATIGUE.

So, you said that you've been participating in physical therap twice weekly for some time...but you didn't specify. Now, muscle fatigue, strain, or overexertion (i.e. using muscles in a way that you're not used to doing) could result in muscle fasicles becoming TWITCHY...and sometimes this TWITCHINESS (when enough small units of each muscle get activated at once) can be felt as a vibration in the body. Have you ever run a long or very hard sprint/race and then, at the finish line just felt like the legs were jello? The fact is they WERE....and that's kind of what can happen to muscles right after surgery and especially after a meniscal type of procedure then you are probably being ramped up slowly...certain muscles that don't usually get called into action to help you walk are now the primary muscles to stabilize the knee and to support your weight. These may fatigue more rapidly than usual due to the extra recruiting force that is being needed....hence sensations of vibrations, quivering, or other odd feelings....UNTIL such time as the knee gets better and you start redistributing your weight to be more normal as it was prior to the surgery. Make sense?

I know that sounds like hand waving...and to some extent it is....but hey, as a doctor that's been doing this for awhile...once in awhile I get to forward a conjecture or 2 without having to prove it beyond a reasonable doubt...HAHA! But, I do think that if your metabolic numbers are all normal as I described above then, my guess you are feeling what you're feeling due to some subtle weakness going on in your muscles involved and as you continue to recuperate and rehabilitate from the surgery this will get less and less.

And so, if I've provided useful or helpful information to your question could you do me the favor of CLOSING THE QUERY along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserved? I'd love to stay in the loop and get some updated information on how things are going in the next few weeks if you can remember to drop me line at: www.bit.ly/drdariushsaghafi ?

You can always reach me at that address for this or other questions. I wish you the best with your symptoms and hope this information helps you.

This query required 60 minutes of professional time to research, assimilate, and respond in complete form.

---

Brief Answer:
Muscle fatigue can lead to vibratory sensation or fine fascicular tremors

Detailed Answer:
Good morning and many thanks for posing your question on Healthcaremagic.

Whenever someone mentions that they are having sensations of vibrations (internally) or a feeling of "shakiness" or quivering that is internally placed without being able to visibly see any muscle twitching or moving the first thing I think of is a NEUROPATHY (nerve malfunction).

Now, in your particular I believe there are a couple of possibilities to consider.

1. The vibratory sense you are having is in fact secondary to a NEUROPATHY which most of the time turns out to be something to do with a metabolic imbalance and this could also include hormonal imbalances in your body.

2. Muscle fatigue can also give a sense of vibratory or quivering internally when a person is fatigued or a muscle is exertionally pushed to a high limit that it is not used to doing.

Let's look at each of those a bit more closely.

1. NEUROPATHY of a metabolic nature. You state that "all blood work numbers good, sugar a little high"--- but you didn't specify which blood tests were good nor did you solidify the information on your sugar so that I could know for certain that you are either not suffering from a HYPERGLYCEMIC state (high sugar which could be transient) vs. a PREDIABETIC state...or even a DIABETIC state.

In order to clarify those issues here is what I suggest. First, find out when the blood draw was performed relative to when you last had anything to eat and drink. If the blood draw was any closer than 4 hrs. and you had just eaten something prior or had a meal then, the high blood sugar may be normal for that setting. I would ask that you get a FASTING BLOOD SUGAR. If there is a potential concern (as in this case that you could have a NEUROPATHY due to the vibrations you're feeling) then, I would also order a Hemoglobin A1C or HbA1C to see how your average glycemic status has been for the past 4-6 weeks. If this number turns out to be elevated then, your doctor will need to see you for some other testing because then, you may either be PREDIABETIC or DIABETIC. So in either of those 2 cases the vibratory sensation you're feeling could be a heralding sign of excessively high sugars which will need to be controlled.

If your testing for diabetes or prediabetes, etc turns out not to result in your having a problem and the elevation was only transient then, we've ruled that issue out.

Then, I would order the following bloodwork which is not always captured or done during routine draws after a procedure such as a meniscus repair:

A. serum Vit. B12
B. serum folate
C. serum Vit. D (total), D2, and D3
D. serum TSH, FT4
E. BUN/Creatinine/EGFR (Estimated Glomerular Filtration Rate)

These several labs are going to be the most common and important to look at when trying to resolve the question as to whether a metabolic neuropathy is afoot or not....make sense?

Now, let's be clear that in the case of Vit. B12 and Vit. D, many neurologists feel that "adequate" levels in the bloodstream in people with neurological issues (or in your case POTENTIAL neurological issues) differ from what the LAB NORMS state. Specifically, I like to see Vit. B12 levels in my patients of at least 400 if not 450 or greater in order to feel that we are not possibly running into a B12 deficiency situation responsible for the problem or symptoms. Vit. D also should be in the neighborhood of 60-80 (in my patients) as opposed to what many labs consider to be normal so long as results are >30...for me that is not enough Vitamin D firepower in the system to be sure that something like neuropathy couldn't be at least treated in part with higher doses.

The BUN/CREAT/EGFR lab values may already be in your bloodwork that you said was all good, except for the EGFR....that is not commonly asked for after an uncomplicated procedure UNLESS you have kidney dysfunction and somebody may be concerned about how your renal status might be following anesthesia administration or something. In this case, it's relevant because we're trying to identify a possible cause of the VIBRATORY sense and possibly calling it a NEUROPATHY.

So, let's say all that bloodwork is pristine, normal, normal, and nothing but normal.....well, then, young lady, I would agree with you that "all blood work numbers good." LOL.....NEXT

NUMBER 2- MUSCLE FATIGUE.

So, you said that you've been participating in physical therap twice weekly for some time...but you didn't specify. Now, muscle fatigue, strain, or overexertion (i.e. using muscles in a way that you're not used to doing) could result in muscle fasicles becoming TWITCHY...and sometimes this TWITCHINESS (when enough small units of each muscle get activated at once) can be felt as a vibration in the body. Have you ever run a long or very hard sprint/race and then, at the finish line just felt like the legs were jello? The fact is they WERE....and that's kind of what can happen to muscles right after surgery and especially after a meniscal type of procedure then you are probably being ramped up slowly...certain muscles that don't usually get called into action to help you walk are now the primary muscles to stabilize the knee and to support your weight. These may fatigue more rapidly than usual due to the extra recruiting force that is being needed....hence sensations of vibrations, quivering, or other odd feelings....UNTIL such time as the knee gets better and you start redistributing your weight to be more normal as it was prior to the surgery. Make sense?

I know that sounds like hand waving...and to some extent it is....but hey, as a doctor that's been doing this for awhile...once in awhile I get to forward a conjecture or 2 without having to prove it beyond a reasonable doubt...HAHA! But, I do think that if your metabolic numbers are all normal as I described above then, my guess you are feeling what you're feeling due to some subtle weakness going on in your muscles involved and as you continue to recuperate and rehabilitate from the surgery this will get less and less.

And so, if I've provided useful or helpful information to your question could you do me the favor of CLOSING THE QUERY along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserved? I'd love to stay in the loop and get some updated information on how things are going in the next few weeks if you can remember to drop me line at: www.bit.ly/drdariushsaghafi ?

You can always reach me at that address for this or other questions. I wish you the best with your symptoms and hope this information helps you.

This query required 60 minutes of professional time to research, assimilate, and respond in complete form.

---