Painful neuromata following upper limb amputation

Geraghty, Timothy; Jones, L. E.

doi:10.3109/03093649609164440

Cited by 63 publications

(43 citation statements)

References 8 publications

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“…The incidence of symptomatic neuroma has only been described in populations affected by trauma. Recorded incidence ranges from 12% to 48% after lower limb amputation, 25% to 26% after upper limb amputation and 8% after digit amputation . Dysvascularity secondary to chronic metabolic disease is an increasingly common cause of lower limb amputation, with rates of neuroma not investigated in these cohorts.…”

Section: Introductionmentioning

confidence: 99%

Incidence and associations of painful neuroma in a contemporary cohort of lower‐limb amputees

Penna

Konstantatos

Cranwell

et al. 2018

ANZ Journal of Surgery

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Section: Introductionmentioning

confidence: 99%

Incidence and associations of painful neuroma in a contemporary cohort of lower‐limb amputees

Penna

Konstantatos

Cranwell

et al. 2018

ANZ Journal of Surgery

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“…Second, there is no consensus as to which envelopment of the proximal stump is optimal. ( Fig 4 ) The proximal stump can be buried in bone[ 10 , 14 – 16 , 33 , 43 , 48 , 51 ], muscle,[ 9 , 10 , 12 , 14 – 16 , 18 , 21 – 29 , 33 , 35 , 41 , 46 – 48 , 51 , 52 , 60 , 66 ] vein[ 12 , 32 , 36 – 38 ] or nerve. [ 13 , 57 , 59 ] Local factors in the area of the damaged nerve play a role in neuropathic pain[ 69 ] and provocation might not be entirely a mechanical problem.…”

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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“…Most symptomatic neuromas involve pain, dysesthesia, hypesthesia, paresthesia, cold intolerance, and most commonly have a Tinel sign at the neuroma site. 5 , 6 …”

Section: Diagnosis and Initial Approachmentioning

confidence: 99%

“…Symptoms of a neuroma include pain (usually sharp or burning), paresthesias, numbness, cold intolerance, and electrical sensitivity, among others. 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

Surgical Algorithm for Neuroma Management: A Changing Treatment Paradigm

Eberlin

Dučić²

2018

Plastic and Reconstructive Surgery - Global Open

131

157

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Successful treatment of the painful neuroma is a particular challenge to the nerve surgeon. Historically, symptomatic neuromas have primarily been treated with excision and implantation techniques, which are inherently passive and do not address the terminal end of the nerve. Over the past decade, the surgical management of neuromas has undergone a paradigm shift synchronous with the development of contemporary techniques aiming to satisfy the nerve end. In this article, we describe the important features of surgical treatment, including the approach to diagnosis with consideration of neuroma type and the decision of partial versus complete neuroma excision. A comprehensive list of the available surgical techniques for management following neuroma excision is presented, the choice of which is often predicated upon the availability of the terminal nerve end for reconstruction. Techniques for neuroma reconstruction in the presence of an intact terminal nerve end include hollow tube reconstruction and auto- or allograft nerve reconstruction. Techniques for neuroma management in the absence of an intact or identifiable terminal nerve end include submuscular or interosseous implantation, centro-central neurorrhaphy, relocation nerve grafting, nerve cap placement, use of regenerative peripheral nerve interface, “end-to-side” neurorrhaphy, and targeted muscle reinnervation. These techniques can be further categorized into passive/ablative and active/reconstructive modalities. The nerve surgeon must be aware of available treatment options and should carefully choose the most appropriate intervention for each patient. Comparative studies are lacking and will be necessary in the future to determine the relative effectiveness of each technique.

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Painful neuromata following upper limb amputation

Cited by 63 publications

References 8 publications

Incidence and associations of painful neuroma in a contemporary cohort of lower‐limb amputees

Incidence and associations of painful neuroma in a contemporary cohort of lower‐limb amputees

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

Surgical Algorithm for Neuroma Management: A Changing Treatment Paradigm

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