Chronic Joint Pain

Chronic joint pain is the outcome of a number of conditions including arthritis, trauma, or infection. The symptoms include pain, swelling, stiffness and limited movement of the joint. When one has chronic joint pain, discomfort does not improve over time, and it becomes increasingly difficult to alleviate the pain with pain medications. Conservative treatment often begins with physical therapy, medications, and splinting. If pain persists, surgery is considered, which may range from endoscopic ‘clean-outs’ and repairs, to joint replacements and fusions. In most cases, this progression of care will lead to the resolution of pain. Unfortunately, some patients’ symptoms never subside, despite each of the listed modalities being employed.

Joint Denervation

At The Institute for Advanced Reconstruction, we have found that including an evaluation of neural origin of the pain, and offering nerve-based treatments, has made a huge difference in the outcome and quality of life for these patients. Like other parts of the body, sensory nerves run throughout the joints, providing sensation (in this case, pain) to a joint’s surrounding structure. Joint pain may be caused by injury or damage to that surrounding nerve. Joint denervation surgery removes a segment of the damaged nerve in order to eliminate or disrupt the chronic pain signal to the brain.

Joint denervation is a relatively simple outpatient procedure–often providing instant and significant pain relief. Although relatively novel, this procedure has actually been in practice since the 1950s. Only recently has it become more widely utilized. With the relief of pain, normal function can be restored to the joint. This allows the surrounding muscles, tendons and other structures to work more effectively, and increases range of motion and general functionality.

Affected joints treated are mostly knees and ankles (weight bearing and constant use exacerbates the pain in these joints), but also the wrist, shoulder or elbow may be affected.

KNEE JOINT

Medial view of the innervation of the knee

Innervation
The knee feels pain from several different nerves. The medial retinacular nerve, the lateral retinacular nerve and the medial cutaneous branch of the saphenous nerve are the most common causes of chronic nerve pain in the knee.

Diagnosis and Nerve Blocks
After gathering a detailed medical history and physical, our physicians may perform a nerve block to see which of the nerves are causing the pain. A nerve block consists of injecting the pain points with local anesthesia and seeing the pain is relieved.

Lateral view of the innervation of the knee

Surgical Technique for Knee Denervation
If the nerve block results in pain relief, you may be a candidate for joint denervation. The surgery is same day, meaning you go home the same day. We make several small (less than 2 inch) incisions to see the nerves causing the problems. Then using magnification, the nerve is cut and removed. The recovery is 1-2 weeks and the pain should be relieved after that. You can walk normally after the procedure. Studies have shown that 80-95% patients have improvement of their pain after surgery.

ANKLE JOINT OR SINUS TARSI

Severe ankle sprains can tear the ligaments that connect several bones of the ankle. The pain can be described as “outside of the ankle” and is called sinus tarsi syndrome. When traditional nonoperative treatment for sinus tarsi syndrome fails, surgical options involve “evacuation” or “curettage” of the contents of the sinus tarsi, ankle arthroscopy, and subtalar fusion. While these surgeries can work to relieve pain, they are quite invasive. Another option is denervation of the ankle to relieve the symptoms of sinus tarsi syndrome.

Drawing of the innervation of the sinus tarsi by the deep peroneal nerve

Innervation of the Sinus Tarsi
The ankle feels sensation from innervation by the deep peroneal nerve. In 25% of patients the sural nerve may provide innervation.

Diagnosis of Sinus Tarsi Pain of Neural Origin
After gathering a detailed history and physical, our physicians may perform a nerve block to see which of the nerves are causing the pain. A nerve block consists of injecting the pain points with local anesthesia and seeing the pain is relieved.

Surgical Technique for Sinus Tarsi Denervation
If the nerve block results in pain relief, you may be a candidate for joint denervation. The surgery is same day, meaning you go home the same day. We make one or two small (less than 2 inch) incisions to see the nerves causing the problems. Then using magnification, the nerve is cut and removed. The recovery is usually 2 to 3 weeks before you are able to return to full activity and the pain should be relieved after that. You can walk normally after the procedure. Studies have shown that 90% patients have improvement of their pain after surgery.



More Information

Contact us today for more information about chronic joint pain treatments.

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