Chronic Saphenous Nerve Entrapment Neuropathy after Closed Blunt Trauma: A Case Report

Neuropathic pain following trauma is a relatively common occurrence; however, diagnostic workup and treatment can be difficult. We present a case of chronic neuropathic pain in which surgical exploration and neurolysis yielded complete remission of pain. Histopathology revealed an array of findings, including evidence of fat necrosis with calcification, granuloma formation, and a foreign body, representing a particularly complex etiology for the patient's symptoms that has not, to our knowledge, been previously reported in the literature.

A 31-year-old female presented to our clinic with chronic neuropathic pain after sustaining a blunt injury to the medial aspect of the right leg 15 years previously while playing softball. Her pain was localized to the anteromedial lower leg and was not relieved by medical management and therapy. She temporarily had complete relief of her symptoms with ultrasound-guided hydrodissection. She was treated with surgical exploration and neurolysis, and postoperatively, the patient had no complications and complete relief of her pain.

We present a case of a 31-year-old patient who had perineural scarring and chronic neuropathic pain necessitating surgical exploration and neurolysis. Our case highlights the importance of investigating the etiology of neuropathic pain with several modalities and demonstrates the utility of ultrasound-guided peripheral nerve hydrodissection for both therapeutic and diagnostic purposes.