The WAITING ROOM => GENERAL KNEE QUESTIONS and comments (good for new threads) => Topic started by: p45 on August 12, 2008, 02:59:29 PM

Title: Saphenous Nerve Entrapment
Post by: p45 on August 12, 2008, 02:59:29 PM
I have been dealing with left knee pain for nearly a year.  After two MRI's (both "normal), three orthopedic surgeons, active release techiques, cotisone injections, physical therapy and being told I have every knee pathology under the sun, I finally recieved a legitimite diagnosis of the entrapment of the infrapatellar branch of the saphenous nerve.  I had been dealing with medial knee pain and numbness across the front of my knee and my family doc nailed the diagnosis when I was injected with a dose of local anesthetic into the nerve.  The pain subsided immediatley, but returned within a few days.  The doc told me this injection was purely diagnostic and that the nerve entrapment would have to heal on its own, which can be a rather lenghty process.  My question is, has anyone else had this same problem and if so what was your treatment and recovery time.  I can only hope there is some sort of treatment other than just time. 
Title: Re: Saphenous Nerve Entrapment
Post by: missmyknee on August 12, 2008, 04:34:23 PM

I've had infrapatellar nerve entrapment several times. Mine were caused by scar tissue forming neuromas. Neuromas are balled up nerves that send out spaghetti like nerves that cause pain. I went thru several modalities of treatment before I had to have them surgically removed. Injecting the local anesthetic is the diagnostic tool to determine this. I had skin sensitivity, tender to touch ( like a bad bruise), burning , some numbness and throbbing pain. I would go thru periods where this would flare up and become an unbearable intensity of all those symptoms. In April I had 6 neuromas removed during 3 hrs of micro surgery, all from the medial side I also had one removed in 06.This type of nerve pain is often overlooked as a source of medial knee pain.

Other treatment options I tried before going to surgery were, ultra sound, TENS unit, oral prescription anti-inflammatories to calm any inflammation to the nerve and cortisone shots and Icing. I also tried nerve pain medications such as Neurontin and Lyrica. You can also ask your doctor to try Lidoderm patches. This is a rectangular patch that is about 4 inches by 8 that can be cut to fit. It sticks to the skin and has lidocaine on it. You wear it 12 hrs then take it off for 12. This provides some numbing to any areas of nerve pain and burning. You can also ask to go into pain management to have your nerve pain managed at a better level.

Surgery for removal, called a neurectomy, is a last resort. This surgery can provide permanent relief . The doctor needs to make sure the nerve ends have been capped by burning the cut ends and embedding them in the muscle or fascia so they can not regenerate. Sometimes nerves around this area get irritated and become a problem. I am currently dealing with this again and pretty sure another neuroma has formed below the surgical area. I am getting ultra sound, taking neurontin , narcotics and lidoderm patches. I form excessive scar tissue, so this is no surprise and my pain management doc said some people just form alot of these , like me..... lucky me.  If you go into pain management make sure they have nerve pain experience.

Here is a link to my blog , I have 3 blogs on my nerve entrapment experience.

Good Luck   ;D

Title: Re: Saphenous Nerve Entrapment
Post by: eaglemom on August 12, 2008, 07:59:51 PM

What timing this is - I'm seeing a neurogolist on Firday for an eng and nerve conduction study.  I need to read up on this.  eagle
Title: Re: Saphenous Nerve Entrapment
Post by: p45 on August 12, 2008, 08:34:20 PM

Thanks for the info.  The most diificult part of all of this is finding a doc that knows about this.  Each ortho I saw gave me textbook diagnosis' of PFPS, MCL bursitis, medial retinacular synovitis, medial plica syndrome, and on and on.  I was seeing a Chiro and explained to him my problems and he initially came up with the possibility of it being an entrapment in the saphenous nerve.  He used active release to try and release the nerve, which worked to some degree, but never made it 100%.  My family doc knew what the problem was right away when I saw him, but he even told me his ability to treat was limited.  He referred me to the "best knee specialist in Kansas City" who discounted the nerve entrapment and told me "you runners and your numbnes." and told me it was probably a stress fracture (it wasn't)  Should I be seeking the advice from a neurologist or other type of doc.  It just seems that if the orthos can't cut on you, they are pretty much disinterested.
Title: Re: Saphenous Nerve Entrapment
Post by: missmyknee on August 12, 2008, 11:52:40 PM

Well , small world, I live just south of KC, however my OS is in Cincinnati !  I used to see an OS in Leawood Ks but have been going to Cinci since 04 . This OS handles my arthrofibrosis and very complex knee. He also diagnosed my nerve problems and did the surgery. They've all been successful but I have developed new ones.

The pain management person here in KC is an anesthesiologist with nerve experience. He gave me several options beginning with medications such as the neurontin, pain med and lidoderm patch. Then I go on to more intensive narcotic combinations, then there is a cryo treatment to freeze the nerve but it could only last a couple months. He said surgery was probably the best method, then mentioned spinal stimulator which I feel is very invasive and would come with it's own set of problems esp with my arthrofibrosis. I had asked my OS if I needed a neurologist and he wanted the pain management doc with nerve experience. The fact that your doc diagnosed it with a local anesthetic means the problem does not originate from the spine so a lumbar block is not necessary. My ortho knew what it was because he has treated it many times and knows all about it. You can try a neurologist and see what they say.

All the different diagnosis's you've had doesn't surprise me as those are all viable reasons for medial side knee pain, but infrapatellar nerve entrapment is often overlooked. When I had the local injection, I had immediate relief but only lasted 8 hrs.

Title: Re: Saphenous Nerve Entrapment
Post by: eaglemom on August 13, 2008, 11:29:24 PM
So what questions should I ask?  I know all of the obvious ones - just want to make certain I know and understand what will be going on.

On a different subject I too come from the Land of Oz!  Born breed and raised there and a very proud KSU Wildcat!!!!! 
Title: Re: Saphenous Nerve Entrapment
Post by: p45 on August 26, 2008, 04:56:47 PM
Just quick update.  I saw a neurologist this week, who seemed very disinterested in my issue and appeared very skeptical of my primary docs diagnoses of an entrapped saphenous nerve.  He did not even look at my knee and did not look at my most recent MRI, even though I was told to bring it.  Anyways, I am scheduled to have an EMG in the a.m..  Anyone have this done for this type of problem.  I have been told by my PT that an EMG will miss this type of entrapment.  I know this is a nerve issue, and I am getting frustrated with doctors not listening to what I am telling them.  I feel that since its a farily uncommon problem, no one is willing to take a closer look.  Thoughts?
Title: Re: Saphenous Nerve Entrapment
Post by: JoniF on August 26, 2008, 05:31:30 PM
Hi P45,

I had an EMG done last year to determine whether or not the nerve had been damaged during my last surgery.  Unfortunately this I was told that this nerve is most commonly damaged after an acl repair.  I was told htat it should take approximately 6mos to one year to heal depending on how hihg up the nerve was damaged.  I was also told that if it does not regenerate within a year then it is considered to be permanently damaged.  Mine has not regnerated, so I am in chronic pain.  Nerve damage shoots out pain signals to random places, so from mid thigh down to my toes is in chronic pain.  I use my TENS unit and was told to take flaxseed oil and fish oil tablets.  I was also on Lyrica, but could not tolerate it's side effects.

Hope this helps and if you have any questions, please feel free to contact me.

Take care,
Title: Re: Saphenous Nerve Entrapment
Post by: missmyknee on August 26, 2008, 07:54:39 PM

Your PCP did the diagnostic for this type of entrapment. Entrapment is different from nerve damage. Entrapment is where something is trapping or constricting the nerve, in my case it is scar tissue wrapping around the nerve. When a local block is done and immediate relief is the result, that confirms it is nerve entrapment. The EMG is done to rule out any involvement originating from the spine. Lumbar blocks are usually used when origination from the spine is involved. Here is a good article regarding this . Page down to the section on Saphenous nerve , the clinical section has info on this.

I've had seven total neuromas / entrapments to the infrapatellar branch of the saphenous nerve....the local blocks and immediate relief confirmed that diagnosis. I now have another one or two that have developed. Sometimes the only way to solve the problem is to have the nerve decompressed. I have had this done because I did not want to take neurontin ( currently on 1800mg for new neuromas) or lyrica any longer than a few months because of the side affects.  My OS is well versed in this type of problem and performed neurolysis and neurectomy to these areas.