CC BY 4.0 · J Brachial Plex Peripher Nerve Inj 2023; 18(01): e6-e9
DOI: 10.1055/s-0043-1767673
Original Contribution

Outcomes of Surgical Treatment of Peripheral Neuromas of the Hand and Forearm

1   Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, Kentucky, United States
2   Department of Orthopedics and Traumatology, Assiut University, Assiut, Egypt
,
Laura Cardenas-Mateus
3   Department of Orthopedics and Traumatology, Hospital Santa Clara, Bogota, Colombia
,
Tsu Min Tsai
1   Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, Kentucky, United States
› Author Affiliations
Funding None of the authors received financial support for this study.

Abstract

The choice of a specific technique for surgical treatment of neuromas remains a problem. The purpose of this study is to determine the overall effectiveness of surgery as well as to find out whether certain surgical procedures are more effective than others. Twenty-nine patients operated between 1998 and 2018 and followed for at least 12 months were reviewed. Clinical assessment included the identification of a pre- and postoperative Tinel sign, pain visual analog score, two-point discrimination (2PD), and grip strength. Mechanisms of injury included clean lacerations (11), crush injuries (11), and other trauma or surgery (7). Mean time from presentation to surgery was 9 months. Seven surgical procedures involving excision in 10 patients and excision and nerve repair in 19 patients were performed. Pain score improved from an average of 7.1 ± 2.3 to 1.8 ± 1.7 with 27 patients (93%) reporting mild or no postoperative pain. Nine patients complained of residual scar hypersensitivity and six patients had residual positive Tinel. No patient required an additional surgical procedure. 2PD improved from an average of 9.6 ± 4.0 to 6.8 ± 1.0. The improvement of pain score and 2PD was statistically significant. Nerve repair resulted in marginally better outcomes, in terms of 2PD and grip strength recovery, than excision alone. The mechanism of injury, zone of involvement, time to intervention, or length of follow-up did not have an impact on the outcomes. Although patient numbers in this study are large in comparison to previous studies, larger patient numbers will allow for a multivariate analysis, which can be possible with a prospective multicenter trial.



Publication History

Received: 20 March 2022

Accepted: 03 February 2023

Article published online:
05 April 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Herndon JH, Eaton RG, Littler JW. Management of painful neuromas in the hand. J Bone Joint Surg Am 1976; 58 (03) 369-373
  • 2 Sunderland S. Nerves and Nerve Injuries. 2nd ed.. Edinburgh: Churchill Livingstone; 1978
  • 3 Cravioto H, Battista A. Clinical and ultrastructural study of painful neuroma. Neurosurgery 1981; 8 (02) 181-190
  • 4 Watson J, Gonzalez M, Romero A, Kerns J. Neuromas of the hand and upper extremity. J Hand Surg Am 2010; 35 (03) 499-510
  • 5 Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 2005; 95 (01) 69-76
  • 6 Fisher GT, Boswick Jr JA. Neuroma formation following digital amputations. J Trauma 1983; 23 (02) 136-142
  • 7 Gotoda Y, Kambara N, Sakai T, Kishi Y, Kodama K, Koyama T. The morbidity, time course and predictive factors for persistent post-thoracotomy pain. Eur J Pain 2001; 5 (01) 89-96
  • 8 Nath R, Mackinnon S. Management of neuromas in the hand. Hand Clin 1996; 12 (04) 745-756
  • 9 Hazari A, Elliot D. Treatment of end-neuromas, neuromas-in-continuity and scarred nerves of the digits by proximal relocation. J Hand Surg [Br] 2004; 29 (04) 338-350
  • 10 Sood MK, Elliot D. Treatment of painful neuromas of the hand and wrist by relocation into the pronator quadratus muscle. J Hand Surg [Br] 1998; 23 (02) 214-219
  • 11 Atherton DD, Fabre J, Anand P, Elliot D. Relocation of painful neuromas in Zone III of the hand and forearm. J Hand Surg Eur Vol 2008; 33 (02) 155-162
  • 12 Atherton DD, Leong JC, Anand P, Elliot D. Relocation of painful end neuromas and scarred nerves from the zone II territory of the hand. J Hand Surg Eur Vol 2007; 32 (01) 38-44
  • 13 Poppler LH, Parikh RP, Bichanich MJ. et al. Surgical interventions for the treatment of painful neuroma: a comparative meta-analysis. Pain 2018; 159 (02) 214-223
  • 14 Guse DM, Moran SL. Outcomes of the surgical treatment of peripheral neuromas of the hand and forearm: a 25-year comparative outcome study. Ann Plast Surg 2013; 71 (06) 654-658
  • 15 Wolvetang NHA, Lans J, Verhiel SHWL, Notermans BJW, Chen NC, Eberlin KR. Surgery for symptomatic neuroma: anatomic distribution and predictors of secondary surgery. Plast Reconstr Surg 2019; 143 (06) 1762-1771
  • 16 Koch H, Haas F, Hubmer M, Rappl T, Scharnagl E. Treatment of painful neuroma by resection and nerve stump transplantation into a vein. Ann Plast Surg 2003; 51 (01) 45-50
  • 17 Oliveira KMC, Pindur L, Han Z, Bhavsar MB, Barker JH, Leppik L. Time course of traumatic neuroma development. PLoS One 2018; 13 (07) e0200548
  • 18 Foucher G, Sammut D, Greant P, Braun FM, Ehrler S, Buch N. Indications and results of skin flaps in painful digital neuroma. J Hand Surg [Br] 1991; 16 (01) 25-29
  • 19 Dellon AL, Mackinnon SE. Treatment of the painful neuroma by neuroma resection and muscle implantation. Plast Reconstr Surg 1986; 77 (03) 427-438
  • 20 Nelson AW. The painful neuroma: the regenerating axon verus the epineural sheath. J Surg Res 1977; 23 (03) 215-221
  • 21 Colgrove RC, Huang EY, Barth AH, Greene MA. Interdigital neuroma: intermuscular neuroma transposition compared with resection. Foot Ankle Int 2000; 21 (03) 206-211