Genicular Nerves: What exactly are they and how do they cause knee pain?
The Genicular nerves are a series of nerves around each knee which take sensation signals such as touch, heat and pain, from the knees up the legs and to the brain. These nerves normally provide sensation and can warn us if we are putting toomuch strain through our knees or if we have something cut our skin.
There are two ways these nerves are important for pain management. The first is if you have osteoarthritis of the knee which is not suitable for surgery such as a knee replacement, and the second is if these nerves are injured in some way.
If you have osteoarthritis or damage to your knee and cartilage, your knee may give you significant pain – affecting your ability to walk and keep the knee muscles, ligaments, tendons and cartilage as strong as they could be. In some circumstances you may want to avoid or postpone knee surgery/replacement such as if you are a younger person. Alternatively, some people just do not want surgery on their knee, or have a medical reason why they can’t have areplacement such as medical conditions like heart disease or lung problems that prevent them from having surgery.
In this circumstance, we can attempt to dampen the pain in your knee, and keep you as active as possible, by scrambling the pain signal in your knee by either heat radiofrequency ablation (burning the nerve) or using electricity to scramble the painsignal using pulsed radiofrequency ablation. Both of which keep your muscle strength and only affect the sensory nerves.
These procedures are minimally invasive and carry minimal risks, but can be very effective in reducing pain to allow you to rehabilitate and strengthen your knee. The procedure dampens pain in 70-80% of people for 6-12 months. It can be repeated again if you need and if you want to avoid medication options for pain and keep the knee as active as possible.
The second situation where we consider treatments for the genicular nerves are if these are possibly damaged in some way. The genicular nerves can be damaged by trauma to the knee, operations including knee replacements and/or arthroscopies. This commonly causes a sharp, electric, burning or throbbing type pain in and around the knee. Your doctor may perform examination of the areas these nerves supply to see if injury to the nerves may be possible.
We will often perform what we call a ‘diagnostic block’ for the genicular nerves to see if these nerves are possibly causing your pain. Under ultrasound or X-ray, we inject local anaesthetic around the nerves to numb them temporarily. We often get you to walk around while the local anaesthetic is working to see if turning off those nerves reduces your pain. If it does, then we suspect the genicular nerves are involved in giving you pain signals. If none of your pain is reduced, then genicular procedures may not work for you and there may be other causes of pain around your knee.
Genicular nerve procedures are commonly performed at Resolve Pain and we are experts in their diagnosis and management. Please talk to your health care team to decide whether a referral or phone call to our service to discuss through your options may be appropriate for you.
*Please be aware this video is not created by Resolve Pain - however has general patient information*