Interdigital direct neurorrhaphy for treatment of painful neuroma due to finger amputation

Martins, Roberto S.; Siqueira, Mário G.; Heise, Carlos Otto; Yeng, Lin Tchia; Andrade, Daniel Ciampi de; Teixeira, Manoel Jacobsen

doi:10.1007/s00701-014-2288-1

Cited by 17 publications

(11 citation statements)

References 33 publications

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“…Patients who experience a digit amputation have a reported 2.7% to 30% incidence of developing a symptomatic neuroma. 1,2 In a nerve injury where the axon is disrupted, the distal portion of the axon will undergo Wallerian degeneration. The proximal portion of the neuron sprouts toward the empty neural tube and will grow 1 to 2 mm per day to restore the nerve's function.…”

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confidence: 99%

Surgical Management of Neuromas of the Hand and Wrist

Regal

Tang

2019

J Am Acad Orthop Surg

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Neuromas of the hand and wrist are common causes of peripheral nerve pain. Neuromas are formed after the nerve sustains an injury, and they can be debilitating and painful. The diagnosis is made by a thorough history and physical examination. The treatment options are quite varied, but conservative measures tailored to the patient should be initiated first. No surgical treatment has been proven superior to others or to nonsurgical treatment.

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confidence: 99%

Surgical Management of Neuromas of the Hand and Wrist

Regal

Tang

2019

J Am Acad Orthop Surg

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“…All patients showed some temporary pain relief after nerve block, and therapeutic results were observed during later follow-up. Their findings indicated that interdigital neurorrhaphy achieved satisfactory improvement of symptoms and hand dysfunction [ 17 ]. Classical surgeries are mostly used in clinical practice and they can indeed provide a certain treatment efficacy.…”

Section: Resultsmentioning

confidence: 99%

Treatments of traumatic neuropathic pain: a systematic review

et al. 2017

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Traumatic neuropathic pain caused by traumatic neuroma has long been bothering both doctors and patients, the mechanisms of traumatic neuropathic pain are widely discussed by researchers and the treatment is challenging. Clinical treatment of painful neuroma is unclear. Numerous treatment modalities have been introduced by experts in this field. However, there is still no single standard recognized treatment.Different forms of treatments have been tested in animals and humans, but pharmacotherapies (antidepressants, antiepileptics) remain the basis of traumatic neuropathic pain management. For intractable cases, nerve stump transpositions into a muscle, vein or bone are seen as traditional surgical procedures which provide a certain degree of efficacy. Novel surgical techniques have emerged in recent years, such as tube guided nerve capping, electrical stimulation and adipose autograft have substantially enriched the abundance of the treatment for traumatic neuropathic pain.Several treatments show advantages over the others in terms of pain relief and prevention of neuroma formation, making it difficult to pick out a single modality as the reference. An effective and standardized treatment for traumatic neuropathic pain would provide better choice for researchers and clinical workers.In this review, we summarized current knowledge on the treatment of traumatic neuropathic pain, and found a therapeutic strategy for this intractable pain. We tried to provide a useful guideline for choosing the right modality in management of traumatic neuropathic pain.

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“…Lidocaine is used in the vast majority of the blocks. [ 7 , 9 , 10 , 12 , 19 – 23 , 29 , 30 , 36 – 39 , 42 , 45 , 46 , 48 – 50 , 52 , 56 , 57 , 60 , 61 , 66 ] It is not known whether a block with a different local anaesthetic, like Bupivacaine[ 13 ] with a longer duration of action may increase the accuracy of prediction.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of a diagnostic block in focal nerve injury with neuropathic pain when surgery is considered

et al. 2018

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ObjectIn patients with focal nerve injury and neuropathic pain cutting the nerve to obtain permanent pain reduction can be considered. Surgery is indicated only if a diagnostic nerve block provides temporary pain relief. We evaluated the predictive value of a block on the outcome of surgery.MethodsIn total, three blocks were performed at two week intervals. Patients were blinded to injections containing lidocaine 1% and a placebo was included. Surgery was offered regardless of the effect of the blocks. Twenty-four patients received 72 blocks. Sixteen patients opted for surgery, 5 patients refrained from surgery, and in 3 the blocks provided permanent pain relief. The predictive ability of the block on the outcome of surgery was assessed by calculating the area under a Receiver Operating Characteristic curve (AUC).ResultsThe AUC of the first lidocaine block was 0.35 with a 95% confidence interval from 0.077 to 0.62. At 95% confidence (two-sided), the AUC is less than 0.62, and hence the predictive ability of the block was poor. The outcome of the second lidocaine block and saline block did not change the conclusion of the first block.ConclusionsWe conclude that the use of blocks to select patients for surgery should be critically appraised.PerspectiveA pain relieving response to one open block is currently considered mandatory before patients with focal nerve injury and neuropathic pain are offered surgery. Blinded blocks including a placebo show that responses for selection should be carefully interpreted because they may not be as predictive as generally presumed.

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Interdigital direct neurorrhaphy for treatment of painful neuroma due to finger amputation

Abstract: Although this study was based on a small number of patients, it indicates that interdigital neurorrhaphy seems to be a feasible surgical treatment for painful digital neuroma.

Cited by 17 publications

References 33 publications

Surgical Management of Neuromas of the Hand and Wrist

Surgical Management of Neuromas of the Hand and Wrist

Treatments of traumatic neuropathic pain: a systematic review

Predictive value of a diagnostic block in focal nerve injury with neuropathic pain when surgery is considered

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