Neuromas of the Hand and Upper Extremity

Watson, Jonathan N.; Gonzalez, Mark H.; Romero, Alex; Kerns, James M.

doi:10.1016/j.jhsa.2009.12.019

Cited by 137 publications

(116 citation statements)

References 54 publications

(77 reference statements)

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“…7 There is no consensus on the optimal management of painful neuromas, with up to 150 various recommendations cited to control neuroma formation. 8,[15][16][17][18][19][20] This is likely attributed a lack of understanding of the pathophysiology of persistent neuromaassociated pain.…”

Section: Discussionmentioning

confidence: 99%

“…6 There are several theories proposed to explain the mechanisms or pathophysiology of this situation, including the persistent mechanical or chemical irritation of the axons, persistent stimulation of the axons within the neuroma via spontaneous discharge, and the gate theory. 7 However, none of these theories can explain this phenomenon completely. 5 Nonetheless, mechanical entrapment of regenerated unhealthy nerve fibers by surrounding scar tissues is generally considered to be the most plausible cause of painful neuromas, and serves as the rationale for treatment modalities that transfer the nerve stump into muscles, veins, or bone.…”

Section: Introductionmentioning

confidence: 99%

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The Expression of α-SMA in the Painful Traumatic Neuroma: Potential Role in the Pathobiology of Neuropathic Pain

Yan

Gao²,

Pan³

et al. 2012

Journal of Neurotrauma

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The exact mechanism of neuroma-associated pain is not yet fully understood, thus contributing to the substantial challenge faced in managing patients with painful neuromas. We aimed to observe the expression of alpha smooth muscle actin (α-SMA) in the painful traumatic neuroma and to investigate its possible roles in the cause of neuroma-associated pain. Its expression is considered to be a useful phenotypic marker for myofibroblast, and may contribute to its increased contractile activity. We collected peripheral neuroma specimens prospectively and subsequently divided them into two groups: painful (n=21) and non-painful (n=27) based on blinded preoperative visual analogue scale (VAS) pain scores. We also harvested normal nerve specimens from the discarded limbs as a control group (n=8). We performed immunohistological studies to observe the expression of α-SMA in each group, and calculated the expression level by a high-resolution pathological image analysis system. There was no positive staining of α-SMA observed in the control group, slight positive staining in the non-painful group, and obviously positive staining in the painful group. Pearson correlation analysis demonstrated that VAS scores were significantly associated with the expression intensity of α-SMA (R=0.831; p<0.001). Linear regression analysis indicated that the expression intensity of α-SMA was positively related to the scale of VAS (R(2)=0.691, p<0.001). These findings suggest that: 1) expression of α-SMA may play certain roles in painful traumatic neuroma, either as a direct cause of neuroma-associated pain or as an indirect marker of local mechanical stimuli, and 2) the presence of α-SMA in the painful group may provide rationale for transpositional procedures in the management of traumatic neuroma. The persistent existence of α-SMA in the painful group and the correlation with VAS scores may provide insight into the development of new therapeutic strategies.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Expression of α-SMA in the Painful Traumatic Neuroma: Potential Role in the Pathobiology of Neuropathic Pain

Yan

Gao²,

Pan³

et al. 2012

Journal of Neurotrauma

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“…14 Neuromas either develop as part of a normal reparative process after nerve injury 15,16 or as a result of chronic irritation, pressure, stretch, poor repair of nerve lesions or previous neuromas, laceration, crush injury, or blunt trauma to nerves. 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.…”

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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“…A painful neuroma is an often debilitating sequela of peripheral nerve injury. The exact pathophysiology of this condition is poorly understood, but it is speculated that nerve endings try to find and reconnect with their distal stumps after trauma [35]. Cutting the nerve can result in a neuroma if no protective measures are taken in advance.…”

Section: Discussionmentioning

confidence: 99%