Peripheral Interventions for Painful Stump Neuromas of the Lower Limb

Poyntz, Stephanie A; Hacking, Nicholas M; Dalal, Milind; Fowler, Stephen J.

doi:10.1097/ajp.0000000000000533

Cited by 13 publications

(11 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[6][7][8] Painful neuromas are often the clinical diagnosis of residual limb pain that arises months after the amputation and are identified from associated tenderness to percussion of the residual limb or a Tinel's sign. [9][10][11] Neuromas are thought to arise due to aberrant axonal regrowth at the area of a nerve injury due to sprouting of the proximal axon. 12 Neuromas may occur on terminal ends of a severed nerve or as a spindle neuroma, which is also referred to as a neuroma-in-continuity, thought to occur after stretch or compression nerve injuries.…”

Section: Introductionmentioning

confidence: 99%

Postamputation Residual Limb Pain Severity and Prevalence: A Systematic Review and Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

Background: Individuals with an extremity amputation are predisposed to persistent pain that reduces their quality of life. Residual limb pain is defined as pain that is felt in the limb after amputation. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review of 5 databases from inception to June 2020 was performed and is registered under the PROSPERO ID: CRD42020199297. Included studies were clinical trials with residual limb pain assessed at a minimum follow-up of 1 week. Meta-analyses of residual limb pain prevalence and severity were performed with subgroups of extremity and amputation etiology. Results: Twenty clinical trials met criteria and reported on a total of 1347 patients. Mean patient ages ranged from 38 to 77. Residual limb pain prevalence at 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years, respectively, was 50%, 11%, 23%, 27%, 22%, and 24%. Mean residual limb pain severity at the 6 months or longer follow-up was 4.19 out of 10 for cancer amputations, 2.70 for traumatic amputations, 0.47 for vasculopathy amputations, 1.01 for lower extremity amputations, and 3.56 for upper extremity amputations. Conclusions: Residual limb pain severity varies according to the etiology of amputation and is more common after upper extremity amputation than lower extremity amputations. The most severe pain is reported by patients undergoing amputations due to cancer, followed by traumatic amputations, while vascular amputation patients report lower pain severity. Promising methods of reducing long-term pain are preoperative pain control, nerve or epidural blocks, use of memantine, calcitonin-containing blocks, and prophylactic nerve coaptations.

show abstract

Section: Introductionmentioning

confidence: 99%

Postamputation Residual Limb Pain Severity and Prevalence: A Systematic Review and Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Donor site symptoms and functional impairment are usually described as mild 13 . Traction neurectomy has been described as a promising neuroma treatment 14 . This technique involves gently pulling on the affected nerve before dissecting it proximally; this mechanism is generally similar to that of nerve stripping, which is why it could be considered a promising approach.…”

Section: Discussionmentioning

confidence: 99%

A Cohort Study on Neuropathic Pain of the Sural Nerve—Can Neurectomy Be Considered a Valid Treatment Option?

et al. 2022

View full text Add to dashboard Cite

BackgroundSural nerve neuroma is often caused by an injury during prior surgery, for example, osteosynthesis or ligament refixations at ankle level. Different surgical techniques to treat neuroma have been described. Neurectomy of an injured symptomatic sural nerve has been described as a treatment option for neuropathic pain. The aim of this study was to evaluate the outcomes of this technique to operatively treat sural nerve neuroma in our department.MethodsFrom 2010 to 2020, a total of 30 consecutive patients with neuropathic pain and suspected neuroma of the sural nerve underwent sural nerve neurectomy. A medical chart review was performed to collect patient-, pain-, and treatment-specific factors. Outcomes were registered.ResultsAfter neurectomy, 22 patients (73.3%) had persisting pain. In logistic regression models evaluating the risk of persisting pain after sural nerve neurectomy, no independent predictor of higher risk of persisting pain could be identified.ConclusionFor sural nerve neuromas, neurectomy remains an option as the surgical morbidity is minor, but patients need to be counseled that only a fourth of those undergoing surgery will be pain-free afterward.

show abstract

“…This is a well-established technique that is often used during amputative procedures to decrease the risk of postoperative neuroma development near the end of the residual limb. 21,28 With this technique the nerve stump retracts away from the surgical incision and subsequent scar tissue. Following prophylactic traction neurectomies, however, we found no statistically significant improvement in postoperative pain scores, Knee Society Scores, or overall patient satisfaction when compared to our control cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Prior to the arthrotomy the nerve was placed under tension and transected sharply to allow the stump to retract away from the incision, as previously described. [20][21][22] Following the neurectomy the surgery was completed in an identical fashion to the control cohort.…”

Section: Methodsmentioning

confidence: 99%

A retrospective case series of prophylactic neurectomy during total knee arthroplasty

Guier

Shi

Clendenen

et al. 2022

J Orthop Surg (Hong Kong)

View full text Add to dashboard Cite

IntroductionTotal knee arthroplasty is a common operation performed to relieve pain and restore functional activity. While overall widely successful, a subset of patients has continued pain postoperatively with no identifiable cause. Neuroma formation has been identified as a possible contributor to this unexplained pain, often necessitating an additional procedure for neuroma removal. The purpose of our study was to evaluate if prophylactic neurectomy could reduce the occurrence of postoperative pain.MethodsA total of 112 patients were compared, 44 control patients and 68 neurectomy patients. Demographic information, Numerical rating pain scale (NRS) and Knee Society Scores (KSS) were collected pre- and post-operatively. Patients were additional asked if they were overall satisfied with the operation.ResultsThere were no differences between groups with respect to age (Median: 71 vs 69 years, p = 0.28), male sex (41% vs 44%, p = 0.85), or body mass index (Median: 32.2 vs 31.3, p = 0.80). When comparing the degree of change following surgery there were no statistically significant differences observed in NRS pain scores (Median change: −7 vs −6, p = 0.89) or KSS scores (Median change: +44 vs +40, p = 0.14). Similarly, there was no statistically significant difference in overall patient-reported satisfaction with the knee replacement (82.5% vs 86.6%, p = 0.59).ConclusionWe did not find a statistically significant difference in NRS, KSS, or overall patient satisfaction between the prophylactic neurectomy and control patient groups. Larger studies with evaluation of the nerve diameter will be needed to determine which patients are at risk for symptomatic neuroma development following total knee arthroplasty.

show abstract

Peripheral Interventions for Painful Stump Neuromas of the Lower Limb

Abstract: The 4 treatments that showed most promise included targeted nerve implantation, traction neurectomy, nerve-to-nerve anastomosis, and perineurial gluing. The short follow-up times and small sample sizes of the studies highlighted the need for more robust clinical studies.

Cited by 13 publications

References 43 publications

Postamputation Residual Limb Pain Severity and Prevalence: A Systematic Review and Meta-Analysis

Postamputation Residual Limb Pain Severity and Prevalence: A Systematic Review and Meta-Analysis

A Cohort Study on Neuropathic Pain of the Sural Nerve—Can Neurectomy Be Considered a Valid Treatment Option?

A retrospective case series of prophylactic neurectomy during total knee arthroplasty

Contact Info

Product

Resources

About