Possibly LE Nerve Entrapment

Hi all,
I have a patient that presents with complaint of posterior knee discomfort/fullness (more medial/distal) and intermittent numbness medial sole of foot extending to the big toe. No previous back injuries or c/o back pain. has had hyper ext knee injury 5 yrs ago with recent minor incident. Thinking scarring? behind knee causing tibal NN entrapment? Am I way off? Any Ax or Tx ideas I could try?
12JAY

hi friend
i think the posterior fullness in knee can be due to intra articular effusion.
check tibiofemoral AP and PA glides
any genu recurvatum present
neurodynamic tests of lower limb
emphasis on tibial nerve with structural differentiation
palpatory findings especially posterior knee
any biomechanical alterations in the lower limb
-at rest
-while functional activities

Quote:

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Originally Posted by jyoung

Hi all,
I have a patient that presents with complaint of posterior knee discomfort/fullness (more medial/distal) and intermittent numbness medial sole of foot extending to the big toe.
Is this with the knee hyper-extended, flexed, mostly straight?
No previous back injuries or c/o back pain. has had hyper ext knee injury 5 yrs ago with recent minor incident. Thinking scarring?
What does the soft tissue 'feel' like?
behind knee causing tibal NN entrapment?
Is the pain eased in certain positions compared to others, i.e. when the knee is slightly flexed is there still toe pain? How about a SLR or Slump test to place tension on that NN, what are the results of those tests?
Am I way off? Any Ax or Tx ideas I could try?
As above really
12JAY

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Just a couple of q's as above

Hi Canuck,
Thanks for your input and questions!
The complaint of discomfort in the post. aspect of the knee is usually with static standing. She stands with her knees in slight hyper extension (5 deg). She has no pain with walking, squating, jumping, or running. SLR and slump test are negative, cause a little bit of tingling but nothing unusual. The numbness in the sole of foot and big toe are intermittent and does not appear to be related to position. The soft tissue in the popliteal fossa feel slightly boggy and appear slightly fuller than the other side. With deep palpation there seems to be a firm lump medial? which is not felt on the other knee. MRI was completely normal for this lady.
Would appreciate any other suggestions.
12JAY

Hi,

I would also check if your client having any flat foot or not coz this would lead to tibial post. tendinitis (coz of over-pronation of foot). And such tendinitis would also lead to some tinnel sign in the post. tibial nerve. Try to check this out.

Furthermore, over-pronation in foot would coz knee problem biomechanically.

Just a thought!!!

if you have cleared all local structures, i would be looking and the lumbar spine. especially L4 - S1. there doesn't have to be pain in the back for it to refer pain. what i normally find is that, with treatment of the lower back, there is increased back pain as the distal pain and numbness subsides.

hope you ruled out saphenous nerve neurodynamically