Genicular Nerve Treatments for Chronic Knee Pain

Understanding the Genicular Nerves

The genicular nerves are small sensory branches around the knee that carry pain signals from the joint to the brain.
By temporarily or permanently interrupting these signals, specialists can significantly reduce chronic knee pain.

Conditions That May Require Genicular Nerve Treatment

• Osteoarthritis of the knee – cartilage wear causes pain, stiffness, and swelling.

• Rheumatoid arthritis – chronic autoimmune inflammation damaging the joint.

• Post-surgical pain – discomfort after procedures such as total knee replacement or arthroscopy.

• Knee injuries – old fractures, ligament tears, or cartilage damage leading to persistent pain.

Signs You May Benefit

• Persistent knee pain lasting 3+ months despite medications or injections

• Pain with movement or weight-bearing (walking, climbing stairs, standing)

• Night pain that disrupts sleep

• Stiffness or reduced range of motion

• Swelling or tenderness around the joint

• Locking, catching, or instability during motion

Diagnosis: Identifying Genicular Nerve Pain

A comprehensive evaluation ensures the right treatment:

• Medical history – details of pain onset, duration, triggers, prior treatments

• Physical exam – checks for swelling, warmth, joint stability, and range of motion

• Diagnostic imaging – X-rays, MRI, or ultrasound to assess arthritis, cartilage loss, or other structural problems

• Diagnostic nerve block – a small amount of local anesthetic is injected around the genicular nerves.
  Significant pain relief after this test confirms that these nerves are the main source of pain.

Genicular Nerve Block: First-Line Interventional Care

A genicular nerve block is usually the first procedure performed once diagnostic testing shows the genicular nerves are the source of pain.
It is minimally invasive, performed in the office or an outpatient setting, and often completed in less than 30 minutes.

How the Procedure Works

• Local anesthesia only: The skin is numbed and a small needle is inserted under X-ray or ultrasound guidance.

• Targeted injection: A small amount of local anesthetic—sometimes combined with a corticosteroid—is delivered around each genicular nerve branch.

• Quick feedback: If knee pain improves significantly in the hours after the block, it confirms the genicular nerves are responsible.

Expected Benefits

• Rapid relief—pain improvement within minutes to hours

• Diagnostic clarity—guides next steps such as radiofrequency ablation

• Temporary but meaningful relief—lasting days to a few weeks; can be repeated if needed

Recovery and Self-Care

• Mild soreness at the injection site may occur for 24–48 hours

• Most patients resume normal activities the same day

• Use ice and over-the-counter pain relievers if recommended by your clinician

When to Consider Radiofrequency Ablation (Genicular Nerve RFA)

If the nerve block gives clear but temporary relief, the next step is often genicular nerve radiofrequency ablation (RFA).
This procedure uses controlled heat to disrupt the nerve’s ability to transmit pain signals, providing longer-lasting benefit.

Procedure Overview

• Preparation: The knee is cleaned and numbed; mild sedation is sometimes offered.

• Precision guidance: A thin probe is placed next to each genicular nerve using X-ray or ultrasound.

• Targeted heat therapy: Radiofrequency energy creates a small lesion on the nerve to stop pain transmission.

Key Advantages

• Pain relief lasting 6–12 months or more

• Improved mobility and daily function

• Reduced need for oral pain medications, including opioids

• Minimally invasive with short recovery time

Possible Side Effects

• Mild temporary soreness or swelling at the treatment site

• Rare infection or bleeding

• Rarely, numbness or weakness around the knee

Integrating Nerve Block and Ablation into a Complete Care Plan

For many patients, the ideal treatment sequence is:

1. Diagnostic genicular nerve block to confirm nerve involvement

2. Radiofrequency ablation for long-term pain relief

3. Ongoing physical therapy and home exercise to strengthen supporting muscles and maintain mobility

4. Lifestyle optimization—weight management, joint-friendly activities, and ergonomics

Recovery, Prognosis, and Long-Term Outcomes

Genicular nerve procedures are designed to reduce chronic knee pain and help patients regain daily function.

Recovery Timeline

• After a nerve block: Most people return to normal activities the same day, with soreness at the injection site resolving in 24–48 hours.
• After radiofrequency ablation: Light activity is typically possible the next day; mild swelling or tenderness may last a few days.

Pain-Relief Duration

• Nerve block: Temporary relief (from a few days to several weeks), often used as a diagnostic step.
• Radiofrequency ablation: Longer relief—typically 6 to 12 months and sometimes longer, depending on individual healing and activity levels.

Repeat Procedures

• If pain returns, the nerve block can be repeated or another RFA session performed.
• Many patients need only periodic treatments to maintain comfort and mobility.

Complementary Lifestyle & Physical Therapy Strategies

For best results, interventional treatments should be combined with rehabilitation and lifestyle management:

• Strength training and flexibility: A physical therapist can create a knee-specific program to strengthen quadriceps, hamstrings, and hip muscles, improving joint stability.
• Low-impact activity: Swimming, cycling, or walking on level surfaces to maintain cardiovascular health without overloading the knee.
• Weight management: Every extra pound adds pressure to the knee joint, accelerating cartilage wear.
• Proper footwear & orthotics: Good shoes or custom inserts help align the knee and reduce stress on the joint.
• Joint-friendly daily habits: Using both hands to lift heavy objects, taking breaks from prolonged sitting or standing, and practicing good posture.

When to Follow Up

Schedule a follow-up visit if you experience:

• Pain that returns or worsens
• New symptoms such as numbness, weakness, or swelling
• Signs of infection (redness, heat, fever)

Ongoing communication with your pain specialist ensures that your treatment plan remains personalized and responsive to your needs.

Risks, Side Effects, and Safety Considerations

Both genicular nerve block and radiofrequency ablation are considered safe, minimally invasive procedures. Still, patients should be aware of potential risks:

• Mild soreness or bruising at the injection site (usually temporary).
• Temporary increase in pain immediately after the procedure before relief begins.
• Numbness or tingling around the knee, generally short-lived.
• Infection risk at the injection site (rare).
• Nerve damage or prolonged numbness (extremely rare).

Your physician will use sterile techniques and image guidance (fluoroscopy or ultrasound) to maximize accuracy and minimize risks.

Diagnosis: How Doctors Decide if You’re a Candidate

Evaluation involves:

• Medical history: Pain duration, severity, activity level, and any past surgeries.
• Physical examination: Testing knee mobility, stability, swelling, and tenderness.
• Imaging: X-rays or MRI scans to identify arthritis, degeneration, or other structural changes.
• Diagnostic nerve block: Relief from a test block confirms that the genicular nerves are contributing to your pain.

Frequently Asked Questions (FAQs)

Q: How do I know if genicular nerve procedures are right for me?
If you have chronic knee pain from arthritis, injury, or post-surgical pain that has not responded to physical therapy, medications, or injections, you may be a candidate.

Q: Will this cure my knee arthritis?
No. These procedures target pain pathways, not the underlying arthritis. They improve quality of life by reducing pain and improving mobility.

Q: How long does the procedure take?
Usually 20–30 minutes, performed in an outpatient setting. Most patients go home the same day.

Q: Can I avoid surgery with this treatment?
For many patients, genicular nerve block or ablation can delay or prevent the need for knee replacement surgery.

Q: How soon will I feel relief?

• Nerve block: Often within hours to a few days.
• Radiofrequency ablation: Typically 2–3 weeks after the procedure, once nerves have been disrupted.

Why Choose Maywell Health for Genicular Nerve Procedures?

• Expertise in advanced interventional pain medicine led by Dr. Brian Mayrsohn.
• Image-guided precision (fluoroscopy & ultrasound) for safe and accurate procedures.
• Personalized treatment plans combining interventions, physical therapy, and lifestyle coaching.
• Whole-person approach addressing both the physical and emotional impacts of chronic pain.

At Maywell Health, our goal is to help you reduce pain, restore function, and live your healthiest, most active life.

Citations

• Choi WJ, Hwang SJ, Song JG, et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain. 2011;152(3):481-487.
• Bhatia A, Peng PWH, Cohen SP. Radiofrequency procedures to relieve chronic knee pain: an evidence-based narrative review. Reg Anesth Pain Med. 2016;41(4):501-510.

Pain Medicine Interventions

• Initial Treatment: Before considering genicular nerve block, patients often try conservative treatments such as oral pain medications (NSAIDs, acetaminophen), physical therapy, and intra-articular steroid injections.
• Combination Therapy: Post-procedure, combining the nerve block with continued physical therapy and possibly adjusting pain medications can optimize pain management and functional outcomes.
• Long-term Management: Regular follow-ups and the possibility of repeat nerve blocks or transitioning to other interventions like radiofrequency ablation for longer-lasting relief.

Lab Tests

• Pre-procedure Testing: Generally, no specific lab tests are required for genicular nerve block. However, basic blood tests might be conducted to rule out any underlying conditions or infections that could complicate the procedure.
• Routine Monitoring: For patients with underlying health conditions, routine blood work might be necessary to ensure overall health and suitability for repeated procedures.