Saphenous Neuralgia is an uncommon nerve problem that causes pain on the inside of the knee.  It is a branch of the femoral nerve with contributions from the L3 and L4 nerve root.  The pain from saphenous neuralgia is described as burning, is located on the medial (inside) portion of the leg and is often worse at night. It may radiate down to the foot.  The pain is worsened by activities such as climbing stairs.  There may be numbness and tingling in the area but no loss of muscle function.  The nerve may be injured by surgery or trauma.  It may become entrapped in a small space called Hunter’s Canal where it travels in the leg.  Diagnosis of saphenous neuralgia is made by history and physical exam.  Electromyography (EMG) and Nerve Conduction Studies (NCV) are useful to determine the exact site of injury in the nerve and to exclude other causes of pain such as herniated disc or diabetic nerve injury.  MRI and CT scan of the leg, pelvis and lumbar spine are useful to exclude other causes of pain and look for tumors or hemorrhage.  Treatment begins with conservative modalities such as rest, heat, ice, physical therapy and analgesics such as non-steroidal anti-inflammatory medications.  Medications such as gabapentin, pregabalin, or the tricyclic antidepressants are useful to treat symptoms.  Injections of the saphenous nerve with a local anesthetic and a steroid may be helpful.  If the nerve is entrapped, surgical release may be necessary.