Knee Sensory Loss: Causes and When to Seek Neurology Help

Diminished sensation in the anterior knee?

Hello, doctor.
I have been doing aerial yoga once a week and occasionally engaging in 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 an electric shock-like sensation when straightening or bending my knee, as if it were stuck with tape.
After about two weeks, this sensation disappeared, 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 a strange feeling when my knee bears weight.
I have been reducing the pressure on my knee.

Reflecting on the day before the symptoms appeared, I had a yoga pose where I lifted my leg, and I felt a sharp pain in my knee.
The next day, I began to experience numbness and subsequent symptoms.
It has been about three months now; the electric shock 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; the first one suggested lumbar spine compression and provided lumbar stretching treatment, but it didn't seem to help much.
The second specialist noted some swelling in my knee, and an ultrasound indicated a ligament injury.
The doctor also found tenderness when pressing on the inner side of my knee (the same area on my right knee does not have this issue).
I am currently undergoing treatment for my knee and would like to ask if the numbness requires a consultation with a neurologist.
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 might 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 that "there is a sensation of numbness and a desire for anesthesia." This is a typical symptom of peripheral nerve injury.
The statement "there is pain when pressing on the inner side of the knee" indicates localized tissue inflammation.
Your symptoms should first consider the possibility of injury to the saphenous nerve near the knee.
Common causes of peripheral nerve injury include acute direct trauma: nerve traction, tearing, or direct compression.
The characteristics of peripheral nerve injury are as follows:
1.
The nature of 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 utilize electrophysiological studies to assist in diagnosis.
Nerve conduction studies assess the conduction velocity and waveform of large fiber nerves.
Electromyography (EMG) evaluates muscle responses in the areas supplied by the affected nerves.
I recommend that you visit a neurology clinic for follow-up examinations, preferably with 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 them!
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 symptoms like numbness, tingling, or a sensation of electric shocks occur. In your case, it seems that the onset of these symptoms followed a specific incident during yoga, which could suggest a link between the activity and your current condition.
The knee is innervated by several nerves, primarily the femoral nerve, which provides sensation to the front of the thigh and the knee. If there is any compression or irritation of these nerves, it can lead to sensory changes such as numbness or tingling. Additionally, issues in the lumbar spine, particularly with the lumbar discs or vertebrae, can also affect the nerves that innervate the lower extremities, leading to similar symptoms.
Given that you have experienced a sensation akin to being "numbed" and have had episodes of sharp pain, it is essential to consider both local knee issues (like ligament injuries or inflammation) and potential referred pain or nerve compression from the lumbar region. The fact that you have seen two different rehabilitation specialists with differing opinions suggests that further investigation may be warranted.

Here are some potential causes for your symptoms:
1. Nerve Compression: As mentioned, lumbar spine issues, such as herniated discs or spinal stenosis, can compress nerves that affect the knee. This could explain the numbness and tingling sensations.

2. Knee Ligament or Meniscus Injury: If there is swelling and tenderness in the knee, it could indicate an injury to the ligaments or meniscus. These injuries can lead to altered mechanics in the knee, which might affect how the nerves function.

3. Inflammation: Conditions like bursitis or tendinitis can cause localized swelling and discomfort, potentially leading to altered sensation in the area.

4. Neuropathy: Peripheral neuropathy, which can be caused by various factors including diabetes, vitamin deficiencies, or other systemic conditions, can also lead to sensory changes in the limbs.

5. Referred Pain: Sometimes, issues in the hip or lower back can manifest as knee pain or altered sensation.

Given that your symptoms have persisted for three months, it is advisable to consult a neurologist. A neurologist can perform specific tests, such as nerve conduction studies or electromyography (EMG), to assess the function of the nerves and determine if there is any underlying nerve damage or compression. They can also evaluate whether the sensory loss is related to a central nervous system issue or a peripheral nerve issue.

In the meantime, it is crucial to continue with your rehabilitation exercises as recommended by your healthcare providers. Avoiding activities that exacerbate your symptoms is also essential. If you notice any worsening of symptoms, such as increased pain, weakness, or changes in bowel or bladder function, seek medical attention immediately.

In summary, while your knee symptoms may be related to local injuries or inflammation, the persistence of sensory changes warrants further evaluation by a neurologist to rule out any significant nerve involvement. Early intervention can be critical in preventing long-term complications and ensuring proper recovery.

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