Management of Chronic Leg and Knee Pain Following Surgery or Trauma Related to Saphenous Nerve and Knee Neuromata

Abstract

Patients who present with lower extremity pain following surgery or trauma can occasionally have the saphenous nerve as the offending anatomic cause of their pain. Consistent with its anatomic course, the saphenous nerve can be the source of pain that manifests anywhere along its sensory distribution.Patients who presented to the Georgetown Peripheral Nerve Institute with lower extremity pain were evaluated, and those patients whose pain was suspected to be of saphenous nerve origin were offered surgical treatment. The surgical intervention included excision of the neuroma and/or nerve decompression, as clinically indicated. Patients were followed clinically and evaluated for both their pain as well as recovery in their ambulation and quality of life.Forty-two consecutive patients underwent surgery for pain of saphenous nerve origin from 2003 to 2008; 69% of these patients had concomitant surgery on another involved lower extremity peripheral nerve. Follow-up was achieved in 35 patients (83% response rate), with an average follow-up duration of 34.7 months. Using a 10-point pain scale, patients reported their preoperative pain as an 8.0 and their postoperative pain as a 2.37 (P < 0.001). Of the 35 patients, 30 (86%) were able to ambulate at the last follow-up encounter. Patients were asked to report their quality of life on a 10-point scale, and reported a 77% recovery of their baseline quality of life as a result of peripheral nerve surgery performed. Of the 35 patients, 29 reported that the surgery effectively resolved their pain, yielding a success rate of 82.8%.The saphenous nerve can be a source of lower extremity and knee pain following trauma or surgery. Accurate clinical diagnosis followed by surgical intervention can result in clinical resolution in the majority of patients, with improvement in ambulation and quality of life. This study reports the largest series of surgically-corrected saphenous neuropathy in the literature.

Comparison of operant escape and reflex tests of nociceptive sensitivity

“…Escape testing shows that early recovery of sensitivity within rostral projecting pain pathways does not occur following bilateral CCI. These results are consistent with the long duration of neuropathic pain and pain sensitization that can be experienced by nerve-injured humans (Belfrage et al, 1995;Correa-Illanes et al, 2012;Ducic et al, 2010;Fernandez-de-las-Penas et al, 2011;Huge et al, 2011;Schon et al, 2001;Sjolund et al, 2001). Therefore, mechanisms for disordered pain processing should be sought several months or later following nerve injury.…”

Ultrasound-Guided Needle Localization of the Saphenous Nerve for Removal of Neuroma in the Infrapatellar Branches

“…The diagnosis of this neuropathic pain is confirmed by reduced pain severity following nerve blockade with local anesthetic agents. 5,6,13 Conservative management includes physical therapy, electrical stimulation, hydrotherapy, oral and topical analgesics, oral agents such as Neurontin (gabapentin) and Lyrica (pregalbin), lidocaine patch applications, and injection of local anesthetic and steroid mixtures. Operative management is well described in the literature and has been shown to be effective in improving knee pain, range of motion, and functional ability.…”

“…2 Neuroma formation in the IPBSN has been previously described as a potential complication of arthroscopic knee procedures and knee arthroplasty, 3 as well as long-term sequelae of trauma from a direct blow. [4][5][6][7] Patients that develop neuromas at these locations experience exquisite anteromedial knee pain with associated stiffness. Treatment options for these patients include operative and nonoperative modalities.…”

Lower Extremity Nerve Decompression in Burn Patients

“…Peroneal nerve decompression has primarily been reported for palsy after orthopedic injury, 2 trauma, direct compression from bedrest, 3 traction injury, 4Y6 but not postburn. Restrictive, 7 diabetic 8 sural neuropathy as well as postsurgical, traumatic, 9,10 infectious, vascular, and oncologic 9 saphenous neuropathy has also been described. However, this is the first series of combined peroneal, sural, and saphenous nerve compression postburn injury, and the largest series of peripheral nerve decompression with the longest follow-up.…”