Saphenous nerve problem

9 messages
10/09/2011 at 15:55
Does anyone have advice for dealing with a trapped Saphenous nerve. I have a numb patch on the inside of my calf and occasional stabbing pain from above the knee down to the same area. The neuro-consultant diagnosed the problem but seems at a loss to know how to fix it (he tells me it's quite rare), suggesting I see a neuro-surgeon for a possible op. I'd prefer to try something less invasive. Rubbing the likely entrapment point (adductor channel above the knee) seems to make it worse. This has been a problem for about 6 months. Any ideas welcome.
OT2
27/10/2011 at 11:34
Hi! I also have an entrapped saphenous nerve, have been injured with this for over a year. I am also struggling to figure out how to fix this, although some things have improved my symptoms but not fixed them. How is your treatment going? Have you found anything that worked for you since your post?
28/10/2011 at 20:32
The short answer is no - I have not found a solution yet.  The long answer. My problems started after a fall in the woods last summer.  I started to get serious knee pain while running so went off to see the sports physio.  "Ah ha" he said  "runners knee" and gave me lots of exercises to strengthen my inner and outer thigh muscles.  With not much improvement after six months I went to see the sports chiropractor.  "Ah ha" he said  "bad alignment" and did some back and hip manipulations.  Knee no better and suddenly I had numb leg and stabbing pain in my inside calf.  Off to the GP, referred to the neuro consultant for electrical conduction studies.  "Ah ha" he said "it's a trapped Saphenous nerve - that's rare - I don't know what you can really do about that - you could try an operation to free the nerve, but it could well just break in the process (being the width of a hair).  Anyway - it's nothing to do with your knee pain - you should go see the knee surgeon".  So off to the knee doctor who did an MRI and discovered that I had a damaged cartilage.  Last week I had keyhole surgery on my knee.  Won't know for a few months but the surgeon (Robert Allum in Windsor, also a keen runner) assures me I should be back to normal running after Christmas.  So my conclusions are that the physio caused the muscles to constrict around the nerve and the chiro tugged the nerve tight.  Ironically I didn't need either.  What to do now?  The very nice Mr Alum recommends just living with it and since it is mainly now a numbness problem I suppose I could.  The neuro consultant also suggested that letting the muscles "atrophy" could help, and the rest I have been forced into probably has done just that.  I have been doing a few Femeral nerve mobilisation routines and that seems a bit (but not much). The sports chiropractor has probably got the solution somewhere but I'm not sure I trust him to know it.  Sorry to have no better answers for you.  Maybe you have some other ideas?
OT2
29/10/2011 at 02:22
Thanks for the reply! I hope the knee surgery fixes your knee! Your problem sounds a bit different to mine, so I'm not sure I'll be much help. I have enough trouble understanding what's wrong with my leg, so can't really suggest anything for you, but I can tell you what's worked for me. Did the injury over a year ago (although I think I might have had this problem for a lot longer without realising and without pain), have pain in my leg above the knee on the inside and had some numbness in areas from the knee down. As my leg has gotten a bit better have had burning and tingling as well, and the numbness has become better. I also had numbness at the top of my things before the injury (which one physio suggested was lateral femoral cutaneous nerve irritation as well as my saphenous nerve problem - and because it is both hips that the problem could be coming from higher up eg. back), and my hips get achy. I've had MRIs which didn't show anything, ultrasounds, which also didn't show anything, although I have symptoms of saphenous nerve entrapment and maybe getting a nerve conduction study done soon. Things that have helped best for me include something called muscle meditation (sounds weird I know... I didn't think it would work but it helped a lot - I find the sore spots in my leg and hold a finger on them gently and think about relaxing the muscle as I breathe out - took a while to get results (and I did it a lot) but got less pain and more feeling in my leg - but it didn't fix the problem. And currently I'm trying pilates with a physio to correct postural problems (back and pelvis - which I think might be causing the muscles in my leg to be too tight and press on the nerve) - and pilates actually has been helping a lot!  It seems to make the pain better. I'm hoping it will fix it... guess I just have to wait and see. I also get on a foam roller a lot to massage my leg - I think it helps a bit too. Trying to avoid surgery, as I would get a massive scar, and I think it can cause scarring around the nerve which may not help. Please let me know how you get on, I too am searching for the answer to this!!
29/10/2011 at 07:52
Saph nerve entrapment/restriction/bind especially the infrapatella branch (I reckon) is a massive player (about 30%) of people with chronic knee pain.

It's massively underdiagnosed an I think a real mismatch of terminology between PTs and OS. The tissue restriction (all the tissue, not just nerve) seem to focus around Hunters canal (lower 1/3rd thigh). Rubbing this will irritate the system. Neurolysis will just scar up later. Injecting it may provide a window of opportunity for you to move better with less pain.

Personally I think you'll need a combo of thoracic spine work (as it affect the sympathetic nervous system), release through Psoas and anterior hip structure, specific myofascial release around Hunters and tape to off load. All combo'd up with a good functional rehab program.

Bake in the oven for 40mins, gas mark 7

HW
OT2
30/10/2011 at 09:00

Thanks HW for the post, I really appreciate the info! Love the last comment lol. I will discuss what you have suggested with my physio tomorrow, she is already working on my thoracic spine and release of my anterior hip structure. (She may be working on the psoas, im not sure...  other physios have tried to release that in the past. and i do have problems with external hip rotation (it makes the symptoms worse) so that's interesting!!) I will also discuss the myofascial release too. Thanks again for the info, have you had this problem yourself or treated it before? (interested to find a practitioner who has successfully treated this - although happy with my current phsyio)

30/10/2011 at 11:25
Hi OT2.  I'd also be keen to find anyone with some direct experience of treating this problem.  So far I have found a few people with opinions but all theoretical, none based on successfully treating in the past.  My knee surgeon said that he had never come across a case of spontaneous Saphenous entrapment, although he'd seen a few caused during operations.  The painful spot 2-3 inches above the inside of the knee seems to be the entrapment point - where the nerve come through the muscle.  This is well documented.  I thought that deep massage around there might well help although as HW says I find that this irritates the nerve in the process and make things temporarily worse.  My neuro consultant proposed an injection here to remove any pains lower in the leg.  This does seem to be a proven solution to pain problems but is only temporary and would need to be repeated every few months.  Would love to hear you make some progress, and if so what works.
30/10/2011 at 12:02
Thanks OT2 - I've treated quite a few, especially when people aren't meant to be getting better....

Midlife's right about the jab Into Hunters canal, but it's not a proven solution because the pain returns. It provides a window of opportunity for rehab to start at a higher level, to move better. Dysfunction sorted, pain goes.

HW
28/12/2012 at 07:02
Just reading your thread, with the comments going back over a year, how are you all getting on now?

I have been having physio for similar sort of problems, I don't get the knee pain anymore. I make sure I stretch and do my exercises. I'm always conscious of my posture... But from time to time my back tightens up when running.

Any further advice on how you've improved since the comments most appreciated

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