Entrapment of the saphenous nerve at the adductor canal affecting the infrapatellar branch - a report on two cases.
This was case report published in the December 2013 edition of the Journal of the Canadian Chiropractic Association. The paper was authored by three chiropractors affiliated with the Canadian Memorial Chiropractic College. The purpose of the paper was to present two cases of saphenous nerve entrapment and to highlight how neural tensioning techniques may aid in the diagnosis and treatment of persistent knee pain.
Entrapment of the saphenous nerve entrapment has been known to mimic a number of different conditions, including but not limited to meniscal tears, stress fracture, bursitis and reflex sympathetic dystrophy. In cases where this diagnosis is missed, patients may have prolonged symptoms or undergo treatments that do not address the primary complaint.
Patients who are at risk of developing entrapment of the saphenous nerve are post-operative knee patients. This is due to the location of the nerve in relation to the surgical site.
This paper reported on two cases of chronic knee pain which had been unresponsive to previous treatment. Both patients were recreational runners who both reported symptoms and pain with physical exertion and at rest. The pain was experienced at various sites in the lower limb and was described as a stabbing type pain, that increased with activity and prolonged standing.
The diagnosis of saphenous nerve entrapment is difficult, this is in part due to lack of validated diagnostic measurements. In this study participants underwent a physical examination, then based on findings in the examination, patients were diagnosed by the clinicians with a suspected nerve entrapment.
Following the diagnosis, clinicians utilized a multi-modal treatment approach consisting of both exercise and manual therapy to address the peripheral nerve entrapment. After a course of treatment both patients had a significant improvement of symptoms and were able to return to physical exercise.
This case report highlights the value of an in-depth physical examination that includes the evaluation and palpation of peripheral nerves. It also demonstrated that in the case of a suspected nerve entrapment a multi-modal treatment approach utilizing both exercise and manual therapy, may be used to manage symptoms.
If you would like to learn more about the study, there is an open access version of the paper available on PubMed.
Key Messages From The Research Summary:
Entrapment of the saphenous nerve may be an overlooked contributor to persistent knee pain.
A combination of manual therapy and exercise may be a useful treatment approach for this condition.
Porr, J., Chrobak, K., & Muir, B. (2013). Entrapment of the saphenous nerve at the adductor canal affecting the infrapatellar branch - a report on two cases. The Journal of the Canadian Chiropractic Association, 57(4), 341-9.
Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24302782