Medial Knee pain and the Saphenous Nerve

If you've been in a physical medicine practice for any length of time, you've seen patients with stubborn tenderness along their medial knee. Sometimes this shows itself to be a clear result of MCL sprain or osteoarthritis, or Patellofemoral dysfunction, or Pes Anserine tendinopathy.
But often -- far more often than our education typically biases us to believe -- there may be a neurogenic inflammatory driver. In other words, the tissues of the medial knee have become mechanically sensitized by inflammatory cytokines secreted by their nerve. In this case, the infrapatellar branch of the Saphenous nerve.
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This video is a quick overview on how I assess and treat saphenous entrapment/neuritis. If you have further interest, I highly suggest doing a Pubmed search on this fascinating condition, and/or perusing these references below.
Settergren, R. (2013). Conservative management of a saphenous nerve entrapment in a female ultra-marathon runner. Journalof Bodywork and Movement Therapies, 17(3), 297-301.
McCrory, Paul & Bell, Simon & Bradshaw, Chris. (2002). Nerve Entrapments of the Lower Leg, Ankle and Foot in Sport. Sports medicine (Auckland, N.Z.). 32. 371-91.
Dunaway D et al. (2005) The Sartorial Branch of the Saphenous Nerve: Its Anatomy at the Joint Line of the Knee. Arthroscopy: The Journal of Arthroscopic & Related Surgery.21:5. 547-551.
Ombregt, L. (2013). Pressure on nerves. In A System of Orthopaedic Medicine (3rd ed., pp. 21-27).
Pecina, M. M., Krmpotic-Nemanic, J., & Markiewitz, A. D. (2001). Tunnel syndromes: Peripheral nerve compression syndromes. Boca Raton: CRC Press.

[@beckyolusegun604]

Well explained sir. Thank you.

[@JMom2408]

Thank you, very helpful and informative.

[@patricianarita8575]

Thank you very much

[@praveenkotulkar]

Very nicely in detail explained. I salute to your teaching

[@RodLucanor]

impressive explanation, excelent guide for the anatomical and functional exploration!

[@mrbenn4385]

Excellent 👌

[@rosemaryalvarez406]

Thank you

[@davidsanders5153]

Thank you so much for this explanation. I have suffered from this pain for more than 10 years after surgery to repair damage from a fall on my knee. At least I have a clue on a line of inquiry, which I will pursue with my healthcare providers. I absolutely have the recurrent medial knee pain and exacerbation on palpitation of the knee and inner thigh.

[@crispybacon2588]

I literally had this nerve maybe several other pinched foot over a week now. Last night I decompressed my back lifting my body, hanging and letting my spine extend in the office chair. My back cracked in 3-4 places and instant relief. Did it one more time and cracked in 2 more places. My knee is still sore but I'm able to walk without pain the rest of the night.

[@dianaecheverria6447]

I had a saphenous nerve block during a TKR five years ago. My knee still hurts, so I'm finally having nerve testing done to look for damage. Great video! Well presented with the skeleton. Thanks for sharing.

[@Knud451]

How do they test for nerve damage?

[@JMom2408]

Did you also have a tourniquet applied to thigh during the TKR. That might be a source of the saphenous nerve injury.

[@monikgagnon]

hi,, very good explanation on my pain,, just wondering if there is a taping when using motion that stresses the sahenous. skiing, skating always brings back the pain even after 6 months no skiing..

[@scorpiogirl0784]

You are amazing. I have been suffering from this condition for a year and a half now and have seen 2 orthopedic surgeons. One is from one of the top universities here is Los Angeles and he looked at me like I was talking another language when I brought up this condition. He also claimed that the location of the pain doesn’t come from the low back. I have 3 herniated disks in my low back. The other surgeon thought the pain was coming from my hips and told me to go get cortisone injections. Unfortunately, I can’t find a doctor in this huge city that understands or knows about saphenous nerve pain and how to fix it. It’s been a nightmare (painful) to say the least.

[@michelen2629]

I am in the excat same boat as you!! I live in a Chicago and so far nobody can help me!! I have 2 bulging discs and I have also been suffering for 1 and a half years! It's a total nightmare. I have had 2 EPI's in my back, 1 SI joint injection, Gel shot in my knee. Been to 2 back surgeons and 2 orthos and a rheumatologist today. How are you doing today?

[@risapowell8190]

Thank you. This has confirmed the other research for my condition. Complication ;is that I have had a TKR in that knee. So am now wondering what tests will confirm this diagnosis? Also, I have some numbness in the bottom of my foot that I believe is related. Not sure what specialist I should see. Thanks again!

[@lynnhoffmann3273]

Wow! Where are you located? I am having numbness on my right medial shin and going to PT for a while now. It seems to be getting better.

[@omedusman5134]

I have infrapatellar neuroma after ACL surgery. All conservative treatment didn’t work. I wonder if surgical treatment is a good solution. How long it takes to recover. Thanks

[@himadrinathnayak8235]

Can it cause knee instability down in stair?

[@skybluefeather397]

3:25 I have this going on. When I tap on it is it throbby and shots across the front of the knee. I'm not understanding how to unload the saphenous nerve. Good video...

[@kingshark3503]

What have you done, I'm having this issue too, check out my comment.

[@mudwiser1391]

Well the saphenous nerve is indeed the source of my pain medial knee pain which goes up into the femoral triangle. Debilitating pain when I walk so what can I do about it?

[@sara.w]

Have you had treatment yet? What was the outcome?

[@floridacoder]

Can you be my doc. Described my symptoms to a T.

[@Knud451]

How you tried any treatments?