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Infrapatellarer Nervenschaden

Vernachlässigte Ursache starker lokalisierter Beinschmerzen

Infrapatellar nerve damage

A neglected cause of severe localized leg pain—German version

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Zusammenfassung

Nach einer Knieoperation oder einem Trauma leidet eine kleine Gruppe von Patienten unter starken andauernden Knieschmerzen. Traumatologen denken in solchen Fällen selten an einen neuropathischen Ursprung derselben. Chronische Schmerzen in Knienähe können durch eine Schädigung des R. infrapatellaris (RI) verursacht werden. Dieser Endast des N. saphenus ist rein sensorisch und aufgrund seines oberflächlichen medialen Verlaufs einem hohen Risiko gegenüber iatrogenen Schädigungen ausgesetzt. Einmal mittels einfacher Tests während der körperlichen Untersuchung erkannt, können verschiedene Behandlungsmethoden vorgeschlagen werden. Jedoch fehlte bisher ein standardisierter Therapiealgorithmus. Diese Studie umfasst 15 Patienten mit einer Schädigung des R. infrapatellaris, denen ein an Intensität zunehmendes Therapieregime – Lidocaininjektionen, gepulste Radiofrequenztherapie (PRF) oder Denervierung – angeboten wurde. Ein Behandlungserfolg (> 50 % Rückgang in der numerischen Schmerzbewertungsskala) wurde in 11 Patienten erreicht (73 %ige Erfolgsrate, Nachbeobachtungszeit im Median 9 Monate). Ziel dieses Beitrags ist, das Wissen über diese Entität zu erweitern und die Wirksamkeit unseres Behandlungsprotokolls zu diskutieren.

Abstract

A small portion of patients suffer from severe knee pain following previous knee surgery or a trauma. Awareness among traumatologists regarding a neuropathic origin of this persistent knee pain is poor. Ongoing pain close to the knee may be caused by damage of the infrapatellar nerve (IN). This branch of the saphenous nerve is purely sensory and is at risk for iatrogenic damage due to its superficial medial course. Once recognized using simple tests during physical examination, a variety of treatment modalities may be proposed. However, a standard treatment algorithm was hitherto absent. This study includes 15 patients having IN damage who were offered a step-up regimen including lidocaine injections, pulsed radiofrequency (PRF) or neurectomy. Success (>50% drop in numeric rating scale pain score) was attained in 11 (73% success rate, 9 month median follow-up). The aim of this contribution is to increase knowledge regarding this illusive entity and to discuss the efficacy of our treatment protocol.

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Authors and Affiliations

  1. Máxima Medical Center, De Run 4600, Postbus 7777, 5500MB, Veldhoven, Niederlande

    William van Dijk, Percy van Eerten &  Marc Scheltinga

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  1. William van Dijk
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  2. Percy van Eerten
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  3. Marc Scheltinga
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Correspondence to Marc Scheltinga.

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Interessenkonflikt

W. van Dijk, P. van Eerten und M. Scheltinga geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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M. Scheltinga, Veldhoven, NL

P. van Eerten, Veldhoven, NL

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van Dijk, W., van Eerten, P. & Scheltinga, M. Infrapatellarer Nervenschaden. Unfallchirurg 122, 860–863 (2019). https://doi.org/10.1007/s00113-019-00721-5

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  • DOI: https://doi.org/10.1007/s00113-019-00721-5

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