Knee Sensory Loss: Causes and Treatment Options

Diminished sensation in the anterior aspect of the knee?

Hello, Doctor.
I have been practicing aerial yoga once a week and occasionally doing light aerobic exercises without any impact or falls that could injure my knees.
One day, I started to feel a tingling sensation in my knee, similar to being numbed, and it felt like a lump when I touched it, but I could walk normally.
Later, I began to experience a sensation like an electric shock when straightening or bending my knee, as if it were stuck with tape.
This sensation disappeared after about two weeks, leaving only a sensory issue in the front of my knee.
I do not experience pain while walking or exercising, but occasionally I feel a deep ache that lasts only a few minutes, and there is some odd feeling when my knee bears weight.
I have been trying to reduce the stress on my knee.

Reflecting on the day before the symptoms began, I remember a yoga pose where I suddenly felt a sharp pain in my knee when lifting my leg, and the next day I started to experience numbness and subsequent symptoms.
It has now been about three months; the electric sensation has disappeared, and I can move my knee freely, but the numbness and the feeling of being numbed still persist.
I consulted a rehabilitation specialist who first suggested lumbar spine compression and provided treatment for that, but it didn't seem effective.
A second specialist noted some swelling in my knee and, after an ultrasound, indicated a ligament injury.
They also found tenderness when pressing on the inner side of my knee (the same area on my right knee did not have any pain).
I am currently undergoing treatment for my knee and would like to ask if I should consult a neurologist regarding the numbness.
I am unsure whether the lumbar spine compression or the ligament inflammation is causing the sensory insensitivity in the front of my knee, and I am worried that three months may affect nerve recovery.
Thank you!

Cao Xiaojie, 20~29 year old female. Ask Date: 2023/06/07

Dr. Jiang Junyi reply Neurology

Dear Ms.
Tsao,
You mentioned, "I feel numbness and still have the sensation of wanting to take anesthetics." This is a typical symptom of peripheral nerve injury.
The statement "I feel pain when pressing on the inner side of my knee" indicates localized tissue inflammation.
Your symptoms should first consider the possibility of damage to the saphenous nerve near the knee.
Common causes of peripheral nerve injury include acute direct trauma: nerve stretching, tearing, or direct compression.
The characteristics of peripheral nerve injury are as follows:
1.
Pain is often described as burning or electric shock-like.
2.
Symptoms have a specific dermatomal distribution, and touching or pressing can provoke symptoms.
Examinations for peripheral nerve issues typically involve electrophysiological studies to assist in diagnosis.
Nerve conduction studies assess the conduction velocity and waveform of large fiber nerves.
Electromyography (EMG) evaluates the muscle response in the areas supplied by the affected nerves.
I recommend that you visit a neurology clinic for follow-up examinations and consult a physician specializing in peripheral nerves, as they have more experience with EMG testing.
Thank you for your inquiry.
If you have further questions, feel free to discuss!
Wishing you good health and peace,
Dr.
Jiang Junyi
Department of Neurology, Taoyuan Hospital

Reply Date: 2023/06/07

More Info

Understanding knee sensory loss can be complex, especially when it involves multiple potential causes such as nerve compression, ligament injuries, or even referred pain from the lumbar spine. Based on your description, it seems that you have experienced a combination of symptoms that may be linked to both your knee and possibly your lumbar spine.

Causes of Knee Sensory Loss
1. Nerve Compression: The sensation of numbness or a "pins and needles" feeling in the knee can often be attributed to nerve compression. This could occur due to issues in the lumbar spine, such as a herniated disc or spinal stenosis, which can compress the nerves that innervate the lower extremities. If the first rehabilitation physician suggested lumbar compression as a cause, it is worth considering further evaluation.

2. Ligament Injury: You mentioned that an ultrasound indicated a ligament injury. Ligament injuries can lead to swelling and inflammation, which might irritate nearby nerves, causing altered sensations in the knee. The fact that you experienced a sudden pain during a yoga pose could suggest a strain or sprain of the ligaments around the knee, which might contribute to your symptoms.

3. Referred Pain: Sometimes, pain or sensory changes in one area can be referred from another area. For example, issues in the lumbar spine can manifest as knee pain or sensory changes due to the interconnected nature of the nervous system.

4. Synovitis or Inflammation: If there is swelling in the knee joint, it can also lead to sensory changes. Inflammation can affect the way nerves transmit signals, leading to sensations of numbness or tingling.

Treatment Options
1. Physical Therapy: Continuing with physical therapy is crucial. A physical therapist can help strengthen the muscles around the knee and lumbar spine, which may alleviate some of the pressure on the nerves and improve overall function. They can also provide specific exercises to improve flexibility and stability.

2. Medication: If inflammation is present, non-steroidal anti-inflammatory drugs (NSAIDs) can be beneficial, but since you mentioned allergies to NSAIDs, alternatives such as acetaminophen or topical analgesics may be considered. Always consult with your healthcare provider before starting any new medication.

3. Neurological Evaluation: Given the persistence of your sensory changes, consulting a neurologist may be warranted. They can perform nerve conduction studies or electromyography (EMG) to assess the function of the nerves and determine if there is any significant nerve damage or compression.

4. Rest and Activity Modification: It’s essential to listen to your body. If certain movements or activities exacerbate your symptoms, it may be wise to modify or avoid them until you have a clearer understanding of the underlying issue.

5. Ice and Compression: If there is swelling, applying ice and using compression wraps can help reduce inflammation and alleviate discomfort.

6. Surgical Options: If conservative treatments do not yield improvements and if significant nerve compression is diagnosed, surgical options may be considered. This would typically be a last resort after other treatments have been exhausted.

Prognosis and Follow-Up
The fact that your electrical sensations have diminished is a positive sign, indicating that your condition may be improving. However, ongoing numbness or altered sensations should be monitored closely. Nerve healing can take time, and while three months may seem lengthy, it is not uncommon for nerve-related issues to resolve gradually.

In summary, it would be prudent to continue your current treatment plan while also considering a referral to a neurologist for further evaluation. This multidisciplinary approach can help ensure that all potential causes of your symptoms are addressed, leading to a more effective treatment strategy. Always keep your healthcare providers informed about any changes in your symptoms, and do not hesitate to seek further opinions if you feel your concerns are not being adequately addressed.

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