Get Relief From Joint Pain

Dr. Eric H. Williams Explains How Joint Pain Can Be Related to Peripheral Nerve Dysfunction

When nerves become damaged or compressed, they can send abnormal pain signals to your joints, leading to chronic aching, burning, or shooting pains. This nerve dysfunction can greatly affect your quality of life, but treatment is available. Baltimore peripheral nerve surgeon Eric H. Williams MD has helped many patients with nerve-related joint pain find relief—and he may be able to do the same for you.

When Is Joint Pain Related to a Peripheral Nerve Issue?

Joint pain refers to discomfort, aches, or soreness in areas where two or more bones meet. This pain can make it nearly impossible to work, complete your day-to-day activities, or spend time with your friends and family or even simply walk.

While most joint pain requires assistance from an orthopedic surgeon who specializes in treating musculoskeletal injuries to the joints, such as arthritis and ligament injuries, what do you do when the orthopedic team tells you that there is nothing more they can offer? What do you do when you have had a knee replacement and still have severe pain? It is times like this when a peripheral surgeon may be able to identify nerves in or next to or around a particular joint that can be causing persistent severe pain in or around the joint. If you’ve consulted an orthopedic surgeon, your joints look as good as they can be, and you’re still having pain six months or more after surgery, the next step is to see a peripheral nerve surgeon like Dr. Williams to determine if a damaged or compressed nerve is responsible.

What Symptoms Indicate That Joint Pain May Be Related to a Peripheral Nerve Problem?

Your peripheral nerves transmit information between the central nervous system and the rest of your body. If your pain is related to a peripheral nerve problem, you might notice the following symptoms:

Radiating pain. If the pain radiates or travels along the path of a specific nerve, it may suggest that the nerve is involved.
Numbness or tingling. If the joint pain is accompanied by numbness, tingling, or a "pins and needles" sensation in the same area, it may indicate nerve irritation or compression or injury.
Weakness. If there is weakness or difficulty moving the affected joint or muscles supplied by the nerve, it could be a sign of nerve involvement.
Exacerbation with certain positions or movements. If the joint pain is worsened by positions or movements that stretch or compress the nerve, it may suggest a nerve issue.
Lack of joint swelling or redness. While not a definitive sign, the absence of visible joint swelling or redness may point away from inflammatory joint conditions and toward a potential nerve problem.
Distribution of symptoms. If the pain and associated symptoms follow the distribution pattern of a specific peripheral nerve, it increases the likelihood of nerve involvement.
Aggravation with activities that increase pressure or tension on the nerve. Activities that increase pressure or tension on the nerve, such as repetitive movements or sustained postures, may exacerbate the symptoms if the nerve is involved.

It's important to note that these symptoms can also occur in other conditions. A proper medical evaluation is necessary to determine the underlying cause of your pain and determine if surgical treatment would be beneficial. This may include diagnostic nerve blocks and imaging studies with MRI, MR neurography, or ultrasound, as well as EMG and nerve conduction studies.

What Types of Joint Pain Does Dr. Williams Treat?

Typically, Dr. Williams treats patients who have joint pain as a complication of a reconstruction or replacement. Some pain after surgery is normal as your body recovers, but pain that lasts six months or more could be a sign of a neuroma or other complication involving the peripheral nerves.

Ankle Pain

If you have had surgery for an ankle fracture or ankle sprain, your joints have been evaluated by an orthopedic surgeon, and you’re still experiencing pain that affects your daily routine, a peripheral nerve problem could be the culprit. Commonly affected nerves include:

Superficial peroneal nerve. A mixed motor and sensory nerve that runs down the lateral aspect of the lower leg, the superficial peroneal nerve provides sensation to the dorsum of the foot and motor function to the muscles that evert and dorsiflex the foot.
Deep peroneal nerve. Another mixed motor and sensory nerve that runs down the front of the leg and innervates the muscles that lift the foot and toes up, the skin in the top of the foot in the first web space between the great toe and second toe, and a portion of the ankle joint.
Sural nerve. A purely sensory nerve that runs down the posterior-lateral aspect of the leg and ankle, the sural nerve provides sensation to the lateral part of the foot and ankle and heel.
Tibial nerve. A major branch of the sciatic nerve that runs down the back of the leg, the tibial nerve provides motor function to the calf muscles and sensation to the sole of the foot, playing a crucial role in ankle and foot movement and sensation.

Knee Pain

Chronic knee pain after knee replacement can be due to peripheral nerves located in and around the knee. If the hardware is intact, seated in the correct place, not loose, and not infected, there is a good chance that your pain is nerve-related. Commonly affected nerves include:

Infrapatellar branch of the saphenous nerve. This is a purely sensory nerve that provides sensation to the skin over the front and inner aspect of the knee.
Anterior femoral cutaneous nerve. This sensory nerve supplies feeling to the skin on the front and outer part of the thigh, extending down to the knee area. It can be a source of both thigh and knee pain if compressed or irritated.
Genicular nerves/retinacular nerves. A network of small nerves that supply sensation to various parts of the knee joint capsule and surrounding structures, the genicular/retinacular nerves are often targeted in nerve ablation procedures to alleviate chronic knee pain.

Shoulder Pain

Shoulder pain after reconstruction can be neuropathic in nature. If all orthopedic considerations have been taken into account, surgical treatment of the affected nerves may provide significant relief of pain and improvement of function. Commonly affected nerves include:

Axillary nerve. A crucial nerve that wraps around the surgical neck of the humerus, providing motor function to the deltoid and teres minor muscles and sensation to the lateral shoulder, the axillary nerve is critical for arm abduction and shoulder stability.
Suprascapular nerve. This nerve passes through the suprascapular and spinoglenoid notches, innervating the supraspinatus and infraspinatus muscles, and is essential for shoulder rotation and arm elevation. It is often implicated in rotator cuff-related shoulder pain.
Lateral pectoral nerve. Primarily a motor nerve, the lateral pectoral nerve innervates the pectoralis major muscle, contributing to shoulder and arm adduction and internal rotation. However, there is a branch of this nerve that travels to the anterior shoulder capsule that can cause significant pain. Its involvement can be considered in cases of anterior shoulder or chest wall pain.

Wrist Pain

If all orthopedic considerations have been ruled out as the primary cause of your persistent pain, the issue may lie with the sensory nerves that innervate the wrist joint. Commonly affected nerves include:

Superficial branch of the radial nerve. A purely sensory nerve that provides sensation to the back aspect of the hand, including the first three fingers and the radial half of the ring finger, the superficial brand of the radial nerve is often implicated in wrist and hand pain on the thumb side.
The terminal branches of the posterior and anterior interosseous nerves. Both of these branches innervate most of the muscles in the forearm, but these nerves ultimately terminate into the wrist joint. When orthopedic care of an injured wrist is maximized, after stability is maintained, removing these nerves can relieve severe chronic refractory wrist pain.
Dorsal sensory branch of the ulnar nerve. A sensory nerve that provides feeling to the back of the hand on the little finger side, including half of the ring finger and the entire little finger, the dorsal sensory branch of the ulnar nerve is often involved in pain after trauma to the outside of the hand.

What Steps Can Patients Take to Prepare for a Visit With Dr. Williams?

Dr. Williams has made it his personal mission to bring relief to patients struggling with chronic pain. To prepare for your first visit, you’ll want to bring:

A detailed description of your symptoms, incorporating accurate descriptive language describing the character and quality of the symptoms.
A timeline of when your pain started and a history of what has transpired in your medical journey since the pain started; this should include who you have seen, what you have done, and medications you have tried or are currently taking.
Relevant medical records from any medical providers you’ve seen, especially those that cover your diagnosis and the specific treatments that have previously been tried, or procedures that may have actually caused your pain.
A list of specific priorities that you might have. We assume that most patients would “like to get better.” This is not helpful. We want to know exactly what areas you want to see improved, what activities you would like to return to, and why you can not do them. Exactly what is keeping you from doing the thing you would like to do?

If you’d like to learn more about the results Dr. Williams has been able to achieve for his patients, we encourage you to check out the testimonials section of our website.