Saphenous Neuropathy Following Medial Knee Trauma

Timothy L. Pendergrass, Josef H. Moore

DOI: 10.2519/jospt.2004.1269

Patients are frequently referred to physical therapy for musculoskeletal injuries. These injuries range from muscle strains to ligament ruptures and bone avulsion fractures. On occasion, what first may appear to be a common musculoskeletal injury can actually develop unexpected sequellae. It is imperative that the physical therapist continue to treat the patient while observing for signs and symptoms that would indicate changes to the initial diagnosis. Reevaluations include examining the progress of the patient and modifying or redirecting interventions.

This is a case report of a patient referred from his primary care physician to physical therapy 6 weeks after suffering a common musculoskeletal injury (diagnosed by the physician as a hamstring muscle contusion). The patient was later determined by a neurologist, and confirmed by a neurosurgeon, to have developed a saphenous neuropathy. Saphenous neuropathy is an uncommon syndrome, accounting for less than 1% of adult patients presenting with lower-extremity pain. True diagnosis is often delayed due to the rarity of the syndrome and the reliance on clinical presentation. Optimal treatment is not known but usually requires injection of local anesthetics with steroids or a surgical nerve release/decompression.

It is important for physical therapists to understand and recognize the signs and symptoms of a saphenous neuropathy. This syndrome is not reported often and can be overlooked or misdiagnosed as it develops. It is equally important for physical therapists to understand their involvement in the primary care team. In that capacity, physical therapists have the opportunity to interact with and refer to other providers. It is important to assimilate the findings of these other care providers as well as the information gathered during initial and follow-up evaluations in the clinic.

J Orthop Sports Phys Ther. 2004; 34(6):328-334.

Key Words: saphenous neuropathy, knee, primary care

Physical therapists must understand and recognize the signs and symptoms of a saphenous neuropathy, a syndrome not often reported and easily overlooked or misdiagnosed as it develops.

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