Neuroma Formation following Digital Amputations

Fisher, Gregory T.; Boswick, John A.

doi:10.1097/00005373-198302000-00012

Cited by 61 publications

(33 citation statements)

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“…It is also plausible that the observed mechanical hyperalgesia in pigs subjected to tail amputation in later life may be functionally-linked to the presence of traumatic neuromas in the resected tail stumps, although no histological examination was carried out as part of this study to confirm it. Increased mechanical sensitivity associated with neuroma development has been reported in humans undergoing both traumatic and elective digital amputations 37 .…”

Section: Discussionmentioning

confidence: 99%

Characterization of short- and long-term mechanical sensitisation following surgical tail amputation in pigs

Giminiani

Edwards

Malcolm

et al. 2017

Sci Rep

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Commercial pigs are frequently exposed to tail mutilations in the form of preventive husbandry procedures (tail docking) or as a result of abnormal behaviour (tail biting). Although tissue and nerve injuries are well-described causes of pain hypersensitivity in humans and in rodent animal models, there is no information on the changes in local pain sensitivity induced by tail injuries in pigs. To determine the temporal profile of sensitisation, pigs were exposed to surgical tail resections and mechanical nociceptive thresholds (MNT) were measured in the acute (one week post-operatively) and in the long-term (either eight or sixteen weeks post-surgery) phase of recovery. The influence of the degree of amputation on MNTs was also evaluated by comparing three different tail-resection treatments (intact, ‘short tail’, ‘long tail’). A significant reduction in MNTs one week following surgery suggests the occurrence of acute sensitisation. Long-term hypersensitivity was also observed in tail-resected pigs at either two or four months following surgery. Tail amputation in pigs appears to evoke acute and sustained changes in peripheral mechanical sensitivity, which resemble features of neuropathic pain reported in humans and other species and provides new information on implications for the welfare of animals subjected to this type of injury.

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Section: Discussionmentioning

confidence: 99%

Characterization of short- and long-term mechanical sensitisation following surgical tail amputation in pigs

Giminiani

Edwards

Malcolm

et al. 2017

Sci Rep

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“…17 They typically develop approximately 6 to 10 weeks after trauma with most presenting within 1 to 12 months after injury or surgery. 15 Gradually enlarging over 2 to 3 years, 18 neuromas may or may not be painful. 19 Two major types of neuromas have been described: terminal and spindle neuromas.…”

Section: Pathophysiologymentioning

confidence: 99%

“…14 Spindle neuromas are found in a peripheral nerve after microtrauma from stretching or compression by local scar tissue. 15 Pain from a neuroma may be secondary to traction on the nerve by scar tissue, 20 compression of the sensitive nerve endings by adjacent soft tissues, 18 ischemia of the nervous tissue, 21 or ectopic foci of ion channels eliciting neuropathic pain. 22,23 Peripheral upregulation of various ion channels and receptors (sodium channels, TRPA1, CGRP, alpha 1C receptors, and nerve growth factor) may also contribute to the neuropathic pain.…”

Section: Pathophysiologymentioning

confidence: 99%

Painful Neuromas

Rajput

Reddy

Shankar

2012

The Clinical Journal of Pain

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Neuromas develop as part of a normal reparative process following peripheral nerve injury. Painful neuromas can induce intense pain resulting in immense suffering and disability. MRI aids the diagnosis, but, ultrasound imaging allows cost effective accurate diagnosis and localization of neuromas by demonstrating their direct contiguity with the nerve of origin. Management options for painful neuromas include pharmacotherapy, prosthetic adjustments, steroid injection, chemical neurolysis, cryoablation, and radiofrequency ablation. Ultrasound imaging guidance has improved the success in localizing and targeting the neuromas. This review discusses the patho-physiology and accumulated evidence for various therapies and the current percutaneous interventional management options for painful neuromas.

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“…In an amputation, there are no distal Schwann cells left to form this coat. Thus, the proximal axons grow and form an extremely sensitive bulbous overgrowth referred to as a terminal neuroma [9]. Spindle neuromas are found away from the transected nerve ending in a peripheral nerve that has been exposed to microtrauma from stretching or compression by local scar tissue [2].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Ultrasound-Guided Extracorporeal Shock Wave Therapy for Painful Stump Neuroma

et al. 2014

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ObjectiveTo investigate the effect of extracorporeal shock wave therapy (ESWT) on painful stump neuroma.MethodsThirty patients with stump neuroma at the distal end of an amputation site were assigned randomly to the ESWT group (n=15) and the transcutaneous electrical nerve stimulation (TENS)+desensitization+pharmacological treatment group (n=15). For 3 weeks, the ESWT group received a weekly session involving 1,500 pulses at 0.10 mJ/mm2, while the control group was treated 10 times each, 40 minutes per day with TENS and desensitization treatment, and daily medication for 3 weeks. ESWT stimulation was given by focusing on the area at the neuroma site clearly identified by ultrasound.ResultsThe changes in the McGill pain questionnaire were 38.8±9.0 prior to treatment and 11.8±3.1 following the treatment. The corresponding values for the control group were 37.2±7.7 and 28.5±10.3. The changes between groups were significantly different (p=0.035). The change in visual analog scale prior to and after treatment was 7.0±1.5 and 2.8±0.8 in the ESWT group, respectively, and 7.2±1.4 and 5.8±2.0 in the control group. These changes between the groups were also significantly different (p=0.010). The outcome in the pain rating scale also showed significant differences between groups (p<0.001). Changes in neuroma size and pain pressure threshold (lb/cm2) were not significantly different between groups (p>0.05).ConclusionThe study findings imply that ESWT for stump neuroma is superior to conventional therapy.

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Neuroma Formation following Digital Amputations

Cited by 61 publications

References 0 publications

Characterization of short- and long-term mechanical sensitisation following surgical tail amputation in pigs

Characterization of short- and long-term mechanical sensitisation following surgical tail amputation in pigs

Painful Neuromas

Outcomes of Ultrasound-Guided Extracorporeal Shock Wave Therapy for Painful Stump Neuroma

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