Saphenous Nerve | Anatomy and Function
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Saphenous nerve entrapment is commonly referred to as Gonalgia Paresthetica, it is a rare but painful condition affecting the saphenous nerve. There is a chronic irritation to the nerve caused by compressions and/or tension. Symptoms include pain, altered sensation such as hypersensitivity, numbness or pins and needles along the dermatome of the nerve.
The dermatome of the nerve is along the inside and front of the knee, and down the inner side of the shin and calf, reaching down to a portion of the arch of the foot. Symptoms can be felt in this whole area or just a portion of it. The most common entrapment or impingement site is where the nerve passes through the adductor canal, also known as Hunter’s canal, the nerve can also get compressed around the inside of the knee and the inner, lower leg.
In most cases, the causes of entrapment are related to repetitive injury and chronic irritation, but an injury to the nerve can occur related to trauma or surgery. Occasionally it may be linked to trauma, but due to the course of the nerve being deep in the leg for the most part it is somewhat protected from injury.
With surgery to the knee such as total knee replacement or anterior cruciate ligament repairs, the saphenous nerve is vulnerable to injury and it is a recorded risk of knee surgery. It is possible with the use of clips during surgery to cause a pinched nerve in the knee and this compression can result in nerve damage in the knee. Additionally, a cut to the nerve may cause more severe damage.
A saphenous nerve entrapment test that is commonly used is the Tinel test, as percussion is applied to the more superficial points of the nerve. This is a common test used for nerve-related pain and injury for different nerves around the body. Additionally, a nerve tension test can be used, which moves the limb in a sequential way to tension the nerve. Both tests can give an indication of whether the nerve is involved with the pain and symptoms experienced and a location where in the nerve this issue may be. Palpation can also give information about the location of the injury, however for a large portion of the course of the saphenous nerve it lies deep in the leg under muscle, therefore palpation is less specific and less effective.
To confirm the diagnosis a nerve conduction study can be performed and radiology such as MRI, ultrasound imaging and x-ray can be used.
Saphenous nerve pain treatment should be directed by a medical professional such as a physical therapist. This is a relatively rare condition, therefore finding a therapist or sports doctor with experience in treating this specific issue is important. Treatments to aid recovery can include rest, massage and exercises, and in many cases, this will be an effective treatment. However, in some cases of persistent pain and other symptoms, these conservative treatments are not adequate and injections or surgery may be necessary.
The conservative management of saphenous nerve pain includes hands-on physical therapy such as massage to the muscles and mobilisation to the joints of the lower back, hip, knee and ankle. Exercises for saphenous nerve entrapment pain similarly include mobility of the joints and muscles along the course of the nerve. They include lower back mobility, glute, quadriceps and calf stretches.
There is a specific exercise that can be done to release the nerve called a nerve glide or sometimes called flossing. Once the course of the nerve has been freed of any stiffness of joints and tightness of muscles the nerve itself can be mobilised. While nerves are not elastic, trying to stretch the nerve will not be effective and in many cases can aggravate symptoms. Nerve glides work to move the nerve along its course by drawing it in one direction followed by the opposite. For the saphenous nerve, this involves extending the hip, abducting your hip, and everting your foot, followed by easing out of this position to allow the nerve to glide back. Standing in a similar to position to a yoga warrior pose. If this is repeated the nerve will slide or glide back and forth which can be an effective way to “free it” and can be effective for pain relief.
Surgery like for many other injuries is a last resort, reserved for when other treatment options have been tried and have been found ineffective at reducing or managing symptoms to a satisfactory level. A saphenous nerve block can be an effective treatment if other treatments has not been effective. Saphenous nerve blocks are carried out under ultrasound guidance to ensure the correct location and administration of the medication. There are two forms of nerve block: surgically and non-surgical.
Epidural anaesthetic or spinal injections of analgesia are injections into the space around the spinal cord.
A peripheral nerve block is an injection to the nerve more local to where the injury is that is causing the pain or symptoms.
Rhizotomy is the surgical destruction of the specific nerve root of the nerve at the spinal cord.
Neurectomy is the surgical destruction of the peripheral nerve causing the symptoms.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.