Nerve Related Joint Pain
Nerve related joint pain is often overlooked as a source of pain in a joint. Oftentimes, patients may be evaluated by multiple medical providers and told that there is nothing wrong with their knee/hip/ankle/shoulder. MRIs and x-rays may also suggest that there is nothing wrong, yet the joint pain persists. If this sounds like you, then your joint pain may in fact be nerve related.
Understanding Nerve related joint pain
Nerve related joint pain is pain in a joint that originates from the sensory nerves that supply the joint and overlying skin with feeling. Each joint has one or more nerves that can be affected. Some of the common causes of nerve related joint pain include:
- Falling on the joint
- Knee replacement
- Ankle sprain
- Car accident
- ACL injury
- Arthroscopic surgery
- Meniscus tear
- Rotator cuff surgery
- Sinus tarsi syndrome
In most cases, the nerves are directly injured either by trauma to the nerve or by a surgery that injured the nerve or caused scarring around the nerve. The affected nerve sends faulty signals to the brain indicating that there is pain in the joint even though there is no reason for the pain. Oftentimes, there is no structural damage to the joint, but nerve pain can sometimes accompany an orthopedic injury. The pain can be acute, meaning recent onset or it can be chronic, meaning the pain has been around for years.
What are the symptoms of nerve related joint pain?
Differentiating nerve pain in joints from other causes can be difficult and easily missed. Imaging studies and EMGs often don’t reveal any injury. So how do you know if you have nerve related joint pain? Nerve related pain is different from orthopedic pain. Patients with nerve pain most often describe the pain as a burning pain, electric shock pain or zinging pain that radiates away from the joint. They are often woken up by the pain. The skin over the joint can be extremely sensitive to touch.
How is nerve related joint pain diagnosed?
Nerve related joint pain is diagnosed by physical exam and by injecting the nerve with local anesthesia. During a physical exam, the nerve is gently tapped and if the zinging pain is reproduced, it is indicated that the pain is likely nerve related. After the troublesome nerve has been identified, it is injected with a small amount of numbing medication (not steroids); this is known as a “nerve block.” The medication only lasts a day or so. If the pain is reduced or gone, then the pain is nerve related.
What procedure do we offer?
At The Institute for Advanced Reconstruction, we perform a surgical procedure called a neurectomy to the nerves causing the pain. Small (1-2 inch) incisions are made in the area where the nerve was injected. The nerve is identified and surgically cut. The end of the nerve is then placed into a nearby muscle so that is does not continue to cause problems. These nerves only supply feeling to the joint, so the area where the nerve is cut will still work like normal, there will just be a little numbness in the area. This procedure is often referred to as “joint denervation surgery.”
This procedure is commonly performed to alleviate nerve related knee pain and ankle pain, but can also address other areas of nerve pain, such as hip pain, wrist pain, shoulder pain and elbow pain.
What is the recovery like after this procedure?
This minimally invasive procedure is usually performed on an outpatient basis. Patients are often able to return to work within one week. Full recovery from this surgery usually takes around two to three weeks. Following recovery from surgery, patients are often pain free and able to resume their normal pre-injury lives.
Please contact The Institute for Advanced Reconstruction if you are interested in learning more about this procedure.