Chronic Unexplained Thigh Pain from Saphenous Nerve Entrapment due to a Leiomyoma

Tertemiz, Oktay Faysal; Akçali, Didem Tuba; Köseoğlu, Belma Füsun; Gökkaya, Nilüfer Kutay Ordu; Uçar, Murat; Esen, Erdinç; Babacan, Avni; Özçakar, Levent

doi:10.1111/pme.12593

Cited by 3 publications

(4 citation statements)

References 6 publications

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“…Nerve tension testing may be incorporated as part of a comprehensive evaluation. The reverse Laségue's test (or prone knee bend test) has been documented for its utility in assessing both femoral nerveof which the saphenous nerve is a branch -and lumbar pathology [6,18,61]. A positive test is unable to discriminate between peripheral and spinal nerve involvement; however, it may reveal a neurogenic condition.…”

Section: Clinical Diagnosismentioning

confidence: 99%

“…Subjective history History of knee surgery or medial thigh and knee trauma Recalcitrant symptoms lasting months to years Neurogenic symptoms along the IBSN distribution Pain with active movement that involves the quadriceps and/or the sartorius muscles [2,10,11,19,54,55,61]. Nerve conduction studies -either sensory nerve action potentials or somatosensory evoked potentials -may also be a part of an evaluation of suspected IBSN injury [10,12,[62][63][64].…”

Section: Examination Relevant Findingsmentioning

confidence: 99%

“…Some authors contest the reliability of these methods [2,13,14,24], and it has been suggested that missed diagnoses may be consequent to focus on the primary branch of the saphenous nerve and not the infrapatellar branch [10]. Imaging, via magnetic resonance imaging (MRI) or computerized tomography (CT), is also utilized for diagnosis [18,22,24,25,61,62]. Occasionally, exploratory surgery is required to identify injury to the IBSN [1,13].…”

Section: Examination Relevant Findingsmentioning

confidence: 99%

“…Medical diagnostic testing takes many forms. The current gold standard involves nerve blocks with Bupivacaine or Lidocaine[2,10,11,19,54,55,61]. Patients often report complete but temporary resolution of symptoms following nerve block…”

mentioning

confidence: 99%

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Infrapatellar Branch of the Saphenous Nerve Injury: Implications for the Physical Therapist

Thompson¹

2021

JRPR

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Injury to the infrapatellar branch of the saphenous nerve (IBSN) is an underreported condition which has important implications for the physical therapist. Due to its location, the IBSN is especially vulnerable to damage following surgery, but it may also be injured through trauma or unknown causes. Patients with suspected IBSN injury may present with a variety of symptoms, including pain along the nerve distribution, paresthesia, hypoesthesia, anesthesia, and impaired functional activities and mobility. As the presence of IBSN injury may not be readily apparent, it is incumbent upon the physical therapist to recognize the signs and symptoms associated with this condition, and to administer a detailed clinical examination. Clinical evaluation can be difficult, as IBSN injury mimics many other conditions of the knee. Additionally, saphenous nerve anatomy exhibits wide variance, even within individuals, making diagnosis challenging. Upon suspicion of IBSN injury, the physical therapist should refer the patient for a comprehensive medical exam, which may include nerve blocks, nerve conduction studies, MRI, CT scan, or exploratory surgery. Most patients respond well to surgical intervention, including neurolysis or neurectomy, though conservative treatment options exist. These include nerve blocks or pharmacologic interventions. Physical therapy treatment is not well reported and may only be appropriate for specific etiologies of injury.

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Section: Clinical Diagnosismentioning

confidence: 99%