Mechanisms and treatment of painful neuromas

Lu, Chang; Sun, Xiaojuan; Wang, Chong; Yü, Wang; Peng, Jiang

doi:10.1515/revneuro-2017-0077

Cited by 43 publications

(45 citation statements)

References 86 publications

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“…Although the other studies did not explicitly diagnose and mention rates of neuroma formation, given the myriad of sensory symptoms among the patient population, we suspect that there is a small but significant portion of the population with stump neuromas. This is concerning because if these neuromas become symptomatic, then they can be a significant source of chronic pain and negatively impact quality of life (Ashkar, Omeroglu, Halwani, et al, 2013;Lu, Sun, Wang, et al, 2018;Vernadakis, Koch, & Mackinnon, 2003). Several anatomical studies helped delineate the surgical anatomy of the sural nerve and its clinical implications (Coert & Dellon, 1994;Eastwood, Irgau, & Atkins, 1992;Williams, 1954).…”

Section: Discussionmentioning

confidence: 99%

Chronic postoperative complications and donor site morbidity after sural nerve autograft harvest or biopsy

Dučić

Yoon

Buncke³

2020

Microsurgery

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Background The sural nerve is the most frequently harvested nerve autograft and is most often biopsied in the workup of peripheral neuropathy. While the complication types associated with these two procedures are well known, their clinical significance is poorly understood and there is a paucity of data regarding the complication rates. Methods Pubmed search identified studies regarding complications after sural nerve harvest and biopsy. The data was grouped into sensory deficits, chronic pain, sensory symptoms, wound infections, wound complications, other postoperative complications, and complications impacting daily life. The incidence of each complication was calculated, and a chi‐square analysis was performed to determine if there were any differences between nerve biopsies and graft harvest with respect to each complication. Results Twelve studies yielded 478 sural nerve procedures. Sensory deficits occurred at a rate of 92.9%, chronic pain at 19.7%, sensory symptoms at 41.1%, wound infections at 5.7%, noninfectious wound complications at 7.8%, and impact on daily life at 5.0%. The differences in wound infections, sensory symptoms, and impact on daily life between biopsies versus graft excisions were found to reach statistical significance (p < .05). Conclusions Sural nerve excisions can cause chronic postoperative donor‐site complications. Given these complications, alternative available mediums for nerve reconstruction should be explored and utilized wherever appropriate. If an alternative medium is unavailable and nerve autograft must be harvested for nerve reconstruction, then patients should be counseled about risks for developing donor site complications that may negatively affect quality of life.

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Section: Discussionmentioning

confidence: 99%

Chronic postoperative complications and donor site morbidity after sural nerve autograft harvest or biopsy

Dučić

Yoon

Buncke³

2020

Microsurgery

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“…Some research has indicated that increasing levels of nerve growth factor, alpha-smooth muscle actin, cannabinoid CB2 receptor, and unmyelinated fiber, as well as changes in peripheral and central sensitization, may be related to neuroma-associated pain. [14] In previous reports, patients typically underwent surgical excision or core needle biopsy. Therapy was generally considered unnecessary for patients who were asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, patients with pain were administered conservative therapy, such as physical therapy, local injection of long-acting local anesthetics, steroid, or surgical excision. [14]…”

Section: Discussionmentioning

confidence: 99%

Traumatic neuroma in mastectomy scar

Chen¹,

Zhang²,

Huang³

et al. 2019

Medicine

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Rationale: Traumatic neuroma is a reparative proliferative response of the nerve after trauma or surgery, which rarely occurs in the breast. However, it must be distinguished from tumor recurrence. Patient concerns: A 78-year-old woman underwent left-sided modified radical mastectomy for invasive carcinoma, 7 years before this case. Two painless nodules near the mastectomy scar were discovered in regular follow-up physical examination. A 62-year-old woman had received right-sided modified radical mastectomy for intraductal carcinoma, 4 years before this case. An asymptomatic nodule near the mastectomy scar was detected during follow-up ultrasound (US) examination. Diagnosis: The lesions in both patients were diagnosed as traumatic neuroma. Interventions: The first patient underwent excisional biopsy. The second patient underwent US guided core-needle aspiration, followed by conservative therapy. Outcomes: Neither patient complained of any discomfort, nor both exhibited normal physical and US findings during follow-up examinations. Lessons: Newly discovered nodules with the benign imaging features near the mastectomy site of a patient, especially with the tail sign, traumatic neuromas should be taken into consideration. Routine US examination is important for follow-up of breast cancer patients who have undergone mastectomy.

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“…An estimated 10% of patients develop an incapacitating painful neuroma following PNS injury [7], either in continuity or as a stump. Ultrasound imaging can detect those neuromas, even if some are very small (e.g., distal sensory nerve neuromas with a CSA of 2 mm 2 where the normal nerve size is 1 mm 2 ).…”

Section: The Role Of Ultrasound In Chronic Pain Following Nerve Traumamentioning

confidence: 99%

“…Peripheral nervous system (PNS) trauma is an infrequent but potentially debilitating disorder, that can have a profound impact on a patient's wellbeing and functional abilities [1]. The overall incidence is estimated to occur in around 2-3% in patients presenting to major trauma centers globally [2][3][4][5][6], and amounts to about 13-23 per 100,000 persons per year [7]. Specific trauma mechanisms have a higher chance of injury to specific nerves, an example being the radial nerve that is affected to some degree in about 10% of the patients with a traumatic humeral shaft fracture.…”

Section: Introductionmentioning

confidence: 99%

Nerve Ultrasound in Traumatic and Iatrogenic Peripheral Nerve Injury

2020

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Peripheral nerve injury is a potentially debilitating disorder that occurs in an estimated 2–3% of all patients with major trauma, in a similar percentage of medical procedures. The workup of these injuries has traditionally been clinical, combined with electrodiagnostic testing. However, this has limitations, especially in the acute phase of the trauma or lack of any recovery, when it is very important to determine nerve continuity and perform surgical exploration and repair in the case of the complete transection or intraneural fibrosis. Ultrasound can help in those situations. It is a versatile imaging technique with a high sensitivity of 93% for detecting focal nerve lesions. Ultrasound can assess the structural integrity of the nerve, neuroma formation and other surrounding abnormalities of bone or foreign bodies impeding the nerve. In addition, this can help to prevent iatrogenic nerve injury by marking the nerve before the procedure. This narrative review gives an overview of why and how nerve ultrasound can play a role in the detection, management and prevention of peripheral nerve injury.

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Mechanisms and treatment of painful neuromas

Cited by 43 publications

References 86 publications

Chronic postoperative complications and donor site morbidity after sural nerve autograft harvest or biopsy

Chronic postoperative complications and donor site morbidity after sural nerve autograft harvest or biopsy

Traumatic neuroma in mastectomy scar

Nerve Ultrasound in Traumatic and Iatrogenic Peripheral Nerve Injury

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