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Nerve Pain in Knee

Have you ever experienced nerve pain in your knee? The pain may not always be there, but you cannot ignore it when it is there.

Why Does It Appear and How to Treat It?

Nerve pain in the knee can be very irritating and life-altering during normal activities as well as leisurely pursuits. Nerve pain in the knee can radiate from the lumbar spine, the pelvis, or the small nerves in the knee. It also can begin after surgery from surgical nerve irritation from the incision or can be the type of pain related to knee arthritis. At the Centeno-Schultz Clinic, we are experts in spine, pain management, and non-surgical orthopedics. We perform a thorough physical examination and musculoskeletal ultrasound of your knee to identify the root cause of your pain and how to treat it appropriately.

What Is Nerve Pain? How Does It Happen?

Nerve pain is typically described as a sensation of burning, tingling, electrical, or a sensation of numbness. Arthritis pain can be more grinding, clicking, popping, swelling, or knee meniscus and ligament issues would be a sensation of instability.

Symptoms of Nerve Pain

Symptoms of the character of nerve pain or neuropathic pain can be described as numbness, tingling, burning, itching, electrical sensations aggravated by certain positions on the nerve or the lumbar spine. A thorough physical examination by Centeno-Schultz Clinic board-certified physicians can help answer the question of whether the nerve pain in the knee is coming from the lumbar spine, peripheral nerves in the leg, or other diagnoses like knee arthritis, ACL laxity, or meniscus degeneration.

Nerve injuries in the knee are common after surgery, like total knee replacement, where the outside nerves get stretched. This can lead to weakness in the ankle commonly referred to as foot drop. There are also superficial sensory nerves that run on the inside and outside of the knee that can be irritated during pressure, certain clothing, knee braces, prior surgery or incisions, or very loose knees, like knock-kneed or bow-legged knees that lead to stretching of the nerves.

Nerve Pain in the Knee Radiating from the Lumbar Spine

This is typically termed Sciatica Syndrome, which is nerve pain going down the leg. Sciatica syndrome, more clearly defined, is typically from lumbar degenerative disc disease or lumbar disc herniation irritating the lumbar spinal nerve roots that refer to pain down the leg.

The nerves in the lumbar spine are numbered 1-5.  Each nerve has a specific role and area that it provides information to. It provides both sensation ( feeling)  and motor information to each area.  It is much like the service panel or fuse box in your home.  The top switch goes to the kitchen whereas the second one goes to the bedroom.  So too with the nerves in the lumbar spine.

In relation to knee nerve pain for example the L2 nerve root provides sensation to the groin and inside thigh above the knee.  L3 provides sensation to the anterior thigh. L4 nerve root irritation can go past the medial (side) and front of the knee towards the kneecap down to the inside of the shin.

There is research clarifying that patients with lumbar degenerative disc disease have lower functional outcomes after total knee replacement patients compared to patients without lumbar degeneration given the sensitivity of the lumbar nerve root. When the Lumbar 2-3 or 3-4 disc is degenerated or bulging, these discs can irritate the nerves that radiate pain to the knee, but also send signals back to the brain of knee pain even though the degeneration is coming from the lumbar spine.

Patellofemoral Stress Syndrome

Alternatively, when we have patellofemoral tracking instability where the kneecap moves laterally, or prior surgery called a lateral release, the superficial nerves around the kneecap can also radiate pain up to the spinal nerve roots and cause a sensation of nerve pain.

Peroneal Nerve Injury

The common peroneal nerve branches behind the knee and this could be irritated from any overuse activity, surgery, instability, or any compression on the outside of the knee. Typically, this will present as pain on the outside of the knee radiating towards the baby toe, the calf, and the lateral shin towards the lateral ankle.

Failed Back Surgery Syndrome

Failed Back Surgery Syndrome also called failed back is a clinical condition in which patients who have undergone low back surgery continue to have pain and dysfunction.  Said another way the surgery that was intended to reduce pain and increase function FAILED. That is right, the surgery failed. You had the surgery, struggled with the pain postoperatively, diligently participated in physical therapy and yet the pain and limitation are still there.  Unfortunately, this occurs frequently.   Estimates range from 20-40% of patients who undergo low back surgery will develop Failed Back Surgery Syndrome. Pain is the most common symptom of Failed Back Surgery Syndrome…

Read More About Failed Back Surgery Syndrome

Herniated Thoracic Disc

A herniated thoracic disc is especially difficult because there aren’t as many treatments available as there are for disc herniations in other areas of the spine. To understand Thoracic Disc Herniations, though,  we first need to cover thoracic spine anatomy and function. With disc herniation, the annulus fibrosus get small tears throughout the annulus. An annulus is a bunch of concentric fibers, so, as the fibers get damaged and cut, the pressure that is built up within the nucleus pushes the now weakened annulus outward, creating a bulge or herniation. The disc begins to weaken via mild degeneration/tearing of the annular fibers…

Read More About Herniated Thoracic Disc

Patellofemoral Syndrome

The kneecap is also known as the patella. The thigh bone is the femur. The patellofemoral joint is formed by the kneecap and the grooved surface of the thigh bone. The patella slides up and down in a grooved track in the femur. The groove is more specifically called the trochlear groove. Like a train that travels on a track, under ideal conditions the patella tracks up and down in the trochlear groove. What is Patellofemoral Syndrome? Patellofemoral syndrome is a medical condition characterized by discomfort in the front of the knee and around the patella. Patellofemoral syndrome may also be known as “jumper’s knee” or “runner’s knee.”…

Read More About Patellofemoral Syndrome

Peroneal Nerve Injury

The common peroneal nerve branches behind the knee and this could be irritated from any overuse activity, surgery, instability, or any compression on the outside of the knee. Typically, this will present as pain on the outside of the knee radiating towards the baby toe, the calf, and the lateral shin towards the lateral ankle. What Causes Peroneal Nerve Compression? There are many potential causes of peroneal nerve compression, such as overuse activities, surgery, instability, or any compression on the outside of the knee. Trauma and nerve compression, especially caused by a fractured or dislocated ankle, can all cause injury to the peroneal nerve. Causes include:

Read More About Peroneal Nerve Injury

Spinal Stenosis

Spinal stenosis is the narrowing of the central spinal canal and is a cause of significant pain and disability.  Common causes of spinal stenosis include disc protrusion, facet overgrowth and ligamentum flavum thickening.  Surgery is often chosen when conservative therapies fail despite the lack of convincing evidence that it is a superior treatment option.  Are there alternatives to back surgery for spinal stenosis?  Yes. Regenexx DDD utilizes precise platelet injections into the facets, muscles, and ligaments to treat the lumbar stenosis, treating all of the components of the issue, which is crucial. Spinal stenosis is often an age-related condition attributed…

Read More About Spinal Stenosis

How Do You Treat Nerve Pain in the Knee?

The Centeno-Schultz Clinic’s board-certified physicians are experts in the diagnosis of both spinal disorders and musculoskeletal and orthopedic disorders. We provide a full 60-minute new patient consultation with a thorough physical examination, neurological examination, musculoskeletal ultrasound of the nerves, the knee joints, the meniscus, and stabilizing ligaments. Initial treatment may include physical therapy, activity modification, and knee bracing. Additionally, medications and injections may be recommended. More definitive treatment would be using your own blood with platelet-rich plasma to help improve the function of the nerves from the lumbar spine, pelvis, and the knee in addition to platelet-rich plasma or bone marrow concentrate, which includes cells and platelet growth factors to improve the knee arthritis and instability.

Should You Be concerned About Nerve Pain in Your Knee?

Nerve pain symptoms of numbness, tingling, and/or weakness going all the way to the foot are abnormal and should be evaluated by a board-certified physician. Some intermittent clicking or a little bit of grinding around the kneecap walking downstairs or hiking in Colorado is typically mild to moderate arthritis and typically does not denote significant nerve-related problems in the knee.

Revolutionary Medical Treatments at the Centeno-Schultz Clinic

Knee nerve pain can be debilitating and require a multitude of medications, surgical procedures, and high-dose corticosteroids like cortisone that can lead to other problems. The board-certified physicians at Centeno-Schultz Clinic have revolutionary treatments validated in peer-reviewed literature to improve the function of the nerve and decrease nerve pain (1).

Using your own blood, platelet-rich plasma, the board-certified physicians at the Centeno-Schultz Clinic are able to inject and hydrodissect around all areas of nerve impingement, leading to your pain. This can include the lumbar nerve roots with an x-ray guided platelet epidural, the SI joint, the sciatic nerve in the pelvis, the sciatic nerve in the thigh, the tibial nerve, or the common peroneal nerve behind the knee. Hydrodissection is an ultrasound-guided injection with extremely small needles to create space around the peripheral nerves in the leg from the tight fascia, muscles, bones, or ligaments that are compressing and irritating the nerve. In addition, the platelets from your own blood improve the function of the nerve.

Can You Prevent Nerve Pain in the Knee from Getting Worse?

Depending on your presenting complaints and diagnosis, we do have recommendations on preventing the nerve pain from getting worse. These may include:

  1. Physical therapy, nerve glides and nerve flossing.
  2. Healthy anti-inflammatories like tumeric and ginger root.
  3. Spinal alignment therapy and pelvic tilting for optimization of the lumbar nerve roots.
  4. Specific nerve supplements including alpha-lipoic acid (ALA), vitamin B complex, lion’s mane, N-acetylcysteine and docosahexaenoic acid (DHA).

Being proactive to prevent the patient from getting worse also includes board-certified physicians performing Interventional Orthopedic treatment using ultrasound-guided or live x-ray fluoroscopy guided injections using the healing agents from the patient’s own body around the areas of nerve irritation in their knee when needed. Being proactive allows patients to maintain their function, improve their pain and slow down the degenerative cascade. Do not take the nerve pain in your knee lightly.

In conclusion, the board-certified physicians at Centeno-Schultz Clinic have more revolutionary new treatments for nerve pain in your knee validated in peer-reviewed literature performed since 2005 at our two offices here in the Denver metropolitan area. If you or a family member have been recommended for surgery or high-dose steroid treatments for nerve pain in their knee, please contact us for a second opinion and a thorough consultation including diagnostic imaging review, physical examination, neurological examination and musculoskeletal ultrasound to discuss your candidacy for our rehabilitative therapies and injection-based therapies to avoid surgery and further compromise your knee function.

If you are interested in learning a new way of knee treatment, please download this Regenexx-SD e-book at centenoschultz.com.

References

Centeno, Christopher et al. “The use of lumbar epidural injection of platelet lysate for treatment of radicular pain.” Journal of experimental orthopaedics vol. 4,1 38. 25 Nov. 2017, doi:10.1186/s40634-017-0113-5.

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