Saphenous Nerve: A Cutaneous Branch of the Femoral Nerve
The saphenous nerve is a branch of the femoral nerve and the nerve’s largest cutaneous branch derived from the femoral nerve. The main branch of the femoral nerve is the motor branch that innervates the quad, while the saphenous nerve and its branches are purely sensory nerves that innervates the skin located over of the inside of the knee. The internal saphenous nerve exits the adductor hiatus just over medial knee, which is a common location for saphenous nerve entrapment. This entrapment is the main mechanism for saphenous nerve neuropathy and likely where a medical professional with perform a saphenous nerve block.
The Internal saphenous vessels and nerves then travel down the inner leg next to the subcutaneous saphenous vein (greater saphenous vein). The vein and nerve continue down the leg until the variable end point of the distal saphenous nerve ends around the distal talocrural joint capsule.
Saphenous Nerve Neuropathy
Any mechanical compression of the saphenous nerve can cause injury of the vessels and nerves creating pain or numbness or burning. This is known as saphenous neuralgia. The most common points of saphenous nerve compression or injury are the inner knee and distal ankle. These are also the most common areas where the nerve is located next to structure that can create mechanical compression injury such as a hiatus in the knee or a crushing injury on top of the tibial bone in the distal ankle.
Saphenous Nerve Entrapment and Knee pain
The adductor canal is an opening in which the cutaneous nerve travels through to supply sensation to the skin over the inner portion of the knee and down the leg. This soft tissue tunnel is a common point that becomes compressed (pinched nerve) or the mobility of the nerve is limited.
Once the nerve exits the adductor hiatus it supplies sensation to the knee via the infra-patallar branches. The saphenous nerve and it’s branches also innervates the heavy ligament on the inner knee known as the Medial Collateral Ligament. This is the ligament that prevents your knee from buckling inwards and gives the knee stability. There sudden or repetitive loading of the inner knee can create saphenous neuralgia.
Activities such as running, walking, standing from sitting and squatting can created pain in the vessels and nerves when the knee traveling towards midline (valgus collapse).
Treatment of Saphenous Neuralgia or Entrapment
- Identify location where the saphenous nerve entrapment or repetitive strain is occurring.
- Use Transverse nerve mobilization Technique or Dermal Traction Method to increase the saphenous nerve at the nerves exits the adductor Haitus (Invented by Dr. Justin Dean)
- Address muscle weakness in the gluteal muscles, control foot pronation, core strength, coordination and proprioception of the hip, knee and ankle joints
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