They are a group of nerves that innervate the knee. There’s a lot of disagreement in the literature as to the origin of the genicular nerves. When patients came back to me, they came for other problems they no longer complain about their knee. Then I experimented with the genicular nerve block – though it wasn’t standard, the results were night and day. There was a time when there was nothing I could offer patients who had pain after a knee replacement, except the saphenous nerve block. For some patients, I terminated their seven-year pain problem, permanently, with just one shot. I’ve seen patients get amazing relief from the genicular block, after years of suffering because nothing else worked. It takes experience with ultrasound to perform these blocks, but the results are undeniable. The genicular nerve block and the suprascapular nerve block are two blocks that really changed my practice about five or six years ago. Genicular Nerve Block – A Black Belt Procedure Perhaps more relevant for the knee, you also have a saphenous nerve, the infrapatellar branch, which is amenable to nerve blocks, cryotherapy, lesioning or neuromodulation to treat nerve pain. Of note on the diagram below are the sciatic nerve, the tibial nerve and the common peroneal nerve. These can be implanted either temporarily or permanently. I’ve done PRP, I’ve done mesenchymal stromal cells and bone marrow aspirate, and I’ve also done neuromodulation placing wires on the saphenous or genicular nerves. I’ve done countless saphenous nerve blocks. In my pain practice, typical alternatives to steroid or visco supplements include a genicular nerve block. His orthopedic has advised replacement, but the patient wants alternatives. There’s also tenderness on the medial aspect of the joint, and it’s negative for drawer’s sign. He has knee pain and crepitus is present on the knee exam with flexion bilaterally. It’s very common for patients to still have arthritis after the procedure. He has significant past surgical history of right arthroscopic meniscectomy. He suffers from coronary artery disease as well as COPD.
He asks about injections of the knee, having already tried steroids and a visco supplement. Patient BackgroundĪ 73-year-old patient presents with bilateral chronic knee pain. You see a dramatic leap in the quality of your results. It’s an easy procedure for physicians who are starting to use ultrasound. I get better results for my patients and in many cases I can bill for ultrasound. It has added a dimension to my practice – a competitive edge.Ī knee injection is one that a lot of physicians are taught to do blind. When I started my pain practice, I met some resistance from other pain doctors on using ultrasound in the office. They wondered what I was going to do with it. My response was that I treat almost anything and everything with ultrasound. Case 3: Ultrasound-guided Injections for Chronic Knee Pain Rosenblum shares how he treats patients for chronic knee pain using nerve blocks. To learn more, watch a recording of the full webinar including guidance on which CPT codes to use for reimbursement in the United States. David Rosenblum, Director of Pain Management at Maimonides Medical Center in New York, recently demonstrated three pain management procedures in a webinar hosted by Clarius. In this post, Dr.
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