Saphenous neuropathy with associated tarsal tunnel syndrome

Majed Quryan Alrowaili

Saphenous neuropathy with associated tarsal tunnel syndrome

Majed Quryan Alrowaili

Abstract

Background:

The lower limb's peripheral nerves can become trapped at different stages of their anatomical development. The foundation of diagnosis is comprised of nerve conduction testing and clinical evaluation. Since its clinical presentation can resemble other more prevalent causes of pain in that anatomical site therefore diagnosing or correctly recognizing these conditions cannot be easy.

Aim and Objectives:

A case of saphenous nerve entrapment in an adductor canal associated with tarsal tunnel syndrome is reported from Saudi Arabia.

Clinical Case report:

A forty five-year-old male presented with sporadic, localized anterior medial right knee pain for two years prior to this diagnosis. The localized pain was progressive and stabbing in nature, present inferior to the patella and with a little medial shift, was intermittent in nature with associated off and on numbness. The progressive entrapment of the saphenous nerve at the vastoadductor membrane was the diagnosis made for the patient. On sensory nerve conduction study, along with the saphenous nerve, the medial and lateral plantar nerves also showed delay in tendencies hence the diagnosis of saphaenous nerve (SN)entrapment at adductor canal along with tarsal tunnel syndrome was made in this patient. Myofascial release therapy was recommended as a conservative measure to free the trapped nerve. After two weeks, the patient pain reduced to no more than a 2 on the Visual analog scale for pain (VAS scale), and after four weeks of physical therapy, the discomfort had completely disappeared. During a 6-month follow-up exercise, the patient's symptoms had resolved and there had been no return of pain or paresthesia.

Conclusions:

Medial knee pain is frequently misdiagnosed as saphenous nerve entrapment because the vastoadductor membrane is often not well-studied. Diagnostic delay usually results from the inability to directly identify the entrapment until after surgical decompression is done. This case study describes the effective diagnosis and non-invasive treatment of an adult male patient's with spontaneous nerve entrapments. A rehabilitation exercise program and physiotherapy can help the patient overcome the knee pain due to SN entrapment.

Keywords

Keywords: nerve, saphenous, entrapment, adductor canal, vastoadductor membrane, pain ,tarsal tunnel syndrome

Full Text:

PDF

References

References:

Ahadi T, Raissi GR, Togha M, Nejati P. Saphenous neuropathy in a patient with low back pain. J Brachial Plex Peripher Nerve Inj. 2010 Jan 16;5:2. doi: 10.1186/1749-7221-5-2.

Beltran LS, Bencardino J, Ghazikhanian V, Beltran J. Entrapment neuropathies III: lower limb. Semin Musculoskelet Radiol. 2010;14(5):501–511. doi: 10.1055/s-0030-1268070.

Espejo-Baena A, Golano P, Meschian S, Garcia-Herrera JM, Serrano Jiménez JM. Complications in medial meniscus suture: a cadaveric study. Knee Surg Sports Traumatol Arthrosc. 2007 Jun;15(6):811-6. doi: 10.1007/s00167-006-0096-8.

Peck E, Finnoff JT, Smith J. Neuropathies in runners. Clin Sports Med. 2010 Jul;29(3):437-57. doi: 10.1016/j.csm.2010.03.002.

Henningsen MH, Jaeger P, Hilsted KL, Dahl JB. Prevalence of saphenous nerve injury after adductor-canal-blockade in patients receiving total knee arthroplasty. Acta Anaesthesiol Scand. 2013 Jan;57(1):112-7. doi: 10.1111/j.1399-6576.2012.02792.x.

Ferkel E, Davis WH, Ellington JK. Entrapment neuropathies of the foot and ankle. Clin Sports Med. 2015;34(4):791–801. doi: 10.1016/j.csm.2015.06.002.

Laurant D.B.-S., Peng P., Arango L.G., Niazi A.U., Chan V.W., Agur A., Perlas A. The nerves of the adductor canal and the innervation of the knee: An anatomic study. Reg. Anesth. Pain Med. 2016;41:321–327. doi: 10.1097/AAP.0000000000000389.

Haraguchi T, Kume S, Jimbo K, Gotoh M, Shiba N, Okawa T. Saphenous nerve entrapment neuropathy after closed tibial fracture: a case report. JBJS Case Connect. 2021;11(2):e20. doi: 10.2106/JBJS.CC.20.00670.

Trescot A, Brown MN, Karl HW. Infrapatellar saphenous neuralgia—diagnosis and treatment. Pain Physician. 2013; 16:E315–24.

Pendergrass TL, Moore JH. Saphenous neuropathy following medial knee trauma. J Orthop Sports Phys Ther. 2004 Jun;34(6):328-34. doi: 10.2519/jospt.2004.1269.

Anagnostopoulou S, Anagnostis G, Saranteas T, Mavrogenis AF, Paraskeuopoulos T. Saphenous and Infrapatellar Nerves at the Adductor Canal: Anatomy and Implications in Regional Anesthesia. Orthopedics. 2016 Mar-Apr;39(2):e259-62. doi: 10.3928/01477447-20160129-03.

De Maeseneer M, Madani H, Lenchik L, Kalume Brigido M, Shahabpour M, Marcelis S, de Mey J, Scafoglieri A. Normal Anatomy and Compression Areas of Nerves of the Foot and Ankle: US and MR Imaging with Anatomic Correlation. Radiographics. 2015 Sep-Oct;35(5):1469-82. doi: 10.1148/rg.2015150028.

Kerver AL, Leliveld MS, den Hartog D, Verhofstad MH, Kleinrensink GJ. The surgical anatomy of the infrapatellar branch of the saphenous nerve in relation to incisions for anteromedial knee surgery. J Bone Joint Surg Am. 2013 Dec 4;95(23):2119-25. doi: 10.2106/JBJS.L.01297.

Hosahalli G, Sierakowski A, Venkatramani H, Sabapathy SR. Entrapment Neuropathy of the Infrapatellar Branch of the Saphenous Nerve: Treated by Partial Division of Sartorius. Indian J Orthop. 2017 Jul-Aug;51(4):474-476. doi: 10.4103/0019-5413.209954.

Grabowski R, Gobbi A, Zabierek S, Domzalski ME. Nonspecific Chronic Anteromedial Knee Pain Neuroma as a Cause of Infrapatellar Pain Syndrome: Case Study and Literature Review. Orthop J Sports Med. 2018 Jan 29;6(1):2325967117751042. doi: 10.1177/2325967117751042.

Calvo-Lobo C, Painceira-Villar R, López-López D, García-Paz V, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Palomo-López P. Tarsal Tunnel Mechanosensitivity Is Increased in Patients with Asthma: A Case-Control Study. J Clin Med. 2018 Dec 12;7(12)

Coppieters MW, Butler DS. Do 'sliders' slide and 'tensioners' tension? An analysis of neurodynamic techniques and considerations regarding their application. Man Ther. 2008 Jun;13(3):213-21. doi: 10.1016/j.math.2006.12.008.

Coppieters MW, Bartholomeeusen KE, Stappaerts KH. Incorporating nerve-gliding techniques in the conservative treatment of cubital tunnel syndrome. J Manipulative Physiol Ther. 2004 Nov-Dec;27(9):560-8. doi: 10.1016/j.jmpt.2004.10.006.

Manoharan D, Sudhakaran D, Goyal A, Srivastava DN, Ansari MT. Clinico-radiological review of peripheral entrapment neuropathies - part 2 Lower limb. Eur J Radiol. 2021;135:109482. doi: 10.1016/j.ejrad.2020.109482.

Kim S-J, Hong SH, Jun WS, Choi J-Y, Myung JS, Jacobson JA, et al. MR imaging mapping of skeletal muscle denervation in entrapment and compressive neuropathies. Radiographics. 2015;35(5):1469–1482. doi: 10.1148/rg.2015150028.

Horn JL, Pitsch T, Salinas F, Benninger B. Anatomic basis to the ultrasound-guided approach for saphenous nerve blockade. Reg Anesth Pain Med. 2009 Sep-Oct;34(5):486-9. doi: 10.1097/AAP.0b013e3181ae11af.

Chang KV, Mezian K, Naňka O, Wu WT, Lou YM, Wang JC, Martinoli C, Özçakar L. Ultrasound Imaging for the Cutaneous Nerves of the Extremities and Relevant Entrapment Syndromes: From Anatomy to Clinical Implications. J Clin Med. 2018 Nov 21;7(11):457. doi: 10.3390/jcm7110457.

Le Corroller T, Lagier A, Pirro N, Champsaur P. Anatomical study of the infrapatellar branch of the saphenous nerve using ultrasonography. Muscle Nerve. 2011 Jul;44(1):50-4. doi: 10.1002/mus.22004.

Porr J, Chrobak K, Muir B. Entrapment of the saphenous nerve at the adductor canal affecting the infrapatellar branch - a report on two cases. J Can Chiropr Assoc. 2013 Dec;57(4):341-9.

Diers DJ. Medial calcaneal nerve entrapment as a cause for chronic heel pain. Physiother Theory Pract. 2008 Jul-Aug;24(4):291-8. doi: 10.1080/09593980701738392.

Salaffi F., Stancati A., Silvestri C.A., Ciapetti A., Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur. J. Pain. 2004;8:283–291. doi: 10.1016/j.ejpain.2003.09.004.