By: Maggie Gebhardt, PT, DPT, OCS, FAAOMPT
A less common source of knee pain and discomfort after knee surgery can be addressed with dry needling by a Physical Therapist. In this case, a patient who is post knee arthroscopy and progressing well can still having medial (inner) knee discomfort towards the end of their plan-of-care. Upon exam everything is normal and there may not be an obvious reason for their continued discomfort. Well, perhaps consider that medial surgical port site as the culprit.
Typically, that port site is where the Saphenous Nerve is taking the turn to travel below (inferior) the knee cap (patella). The Saphenous nerve is a sensory nerve, so the only manifestation of it being impacted could be pain with no obvious strength deficits. There is a specific neural tension test to use as an objective measure, but otherwise it would be hard to specifically identify this nerve as the impacted structure. However, once you identify a nerve entrapment the question should be, “why?” Well, back to that port site…
As the scar tissue from the incision is forming, sometimes sprouting off the Saphenous Nerve can become entrapped within the newly formed scar tissue, especially if the scar tissue is developing abnormally. These small entrapments can cause nerve-like pain sensations in the general vicinity of the Saphenous Nerve. You try some nerve gliding, but if the nerve is entrapped, the glides are going to have minimal effects. You need to get that nerve “unstuck!” Implementing fascial and scar tissue techniques with needling should break up any entrapments caused by scar tissue at this port site and allow the Saphenous nerve to move freely. Overtime, along with restoration of normal neural mechanics, that patient’s pain should subside allowing them to freely return to function!
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