Diagnostic Criteria for Symptomatic Neuroma

Abstract

Introduction After nerve injury, disorganized or incomplete nerve regeneration may result in a neuroma. The true incidence of symptomatic neuroma is unknown, and the diagnosis has traditionally been made based on patient history, symptoms, physical examination, and the anatomic location of pain, along with response to diagnostic injection. There are no formally accepted criteria for a diagnosis of neuroma. Materials and Methods A literature search was performed to identify articles related to neuroma: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and Pubmed, Embase, and the Cochrane Library were searched for all relevant articles pertaining to neuroma. Articles were screened by title and abstract for relevance. If an article was considered potentially relevant, the full article was reviewed. After consideration, 50 articles were included in this systematic review. Results No previous articles directly addressed diagnostic criteria for symptomatic neuroma. Factors related to neuroma diagnosis gleaned from previous studies include pain and cold intolerance (patient history), positive Tinel sign or diminished 2-point discrimination (physical examination findings), response to diagnostic nerve block, and presence of neuroma on diagnostic imaging (ultrasound or magnetic resonance imaging). Based on literature review, the importance and number of references, as well as clinical experience, we propose criteria for diagnosis of symptomatic neuroma. To receive a diagnosis of symptomatic neuroma, patients must have (1) pain with at least 3 qualifying “neuropathic” characteristics, (2) symptoms in a defined neural anatomic distribution, and (3) a history of a nerve injury or suspected nerve injury. In addition, patients must have at least 2 of the following 4 findings: (1) positive Tinel sign on examination at/along suspected nerve injury site, (2) tenderness/pain on examination at/along suspected nerve injury site, (3) positive response to a diagnostic local anesthetic injection, and (4) ultrasound or magnetic resonance imaging confirmation of neuroma. Conclusions The diagnosis of neuroma is based on a careful history and physical examination and should rely on the proposed criteria for confirmation. These criteria will be helpful in more precisely defining the diagnosis for clinical and research purposes.

Regenerative Peripheral Nerve Interfaces for the Management of Symptomatic Hand and Digital Neuromas

“…Symptomatic neuromas of the hand or digits decreases an individual’s quality of life due to both neuropathic pain and to the fear of pain elicited with attempted use of the affected extremity. 1 – 3 , 13 – 16 These patients rely on opioids, neuropathic, and/or antidepressant medications for symptomatic relief. However, such treatments are sedating, associated with dependence and overdose, and often ineffective.…”

Clinical Outcomes of Symptomatic Neuroma Resection and Reconstruction with Processed Nerve Allograft

“…Given the registry-based nature of the study, we were unable to determine the diagnostic methods used for the patients included in this study. However, one recent meta-analysis of 50 articles 37 has identified criteria that may assist in the diagnosis of symptomatic neuroma to help determine which patients may benefit from neuroma surgery. These criteria include a history of nerve injury, with symptoms in a defined anatomical distribution and pain with at least three of the following characteristics: burning, sharp, shooting, electric paresthesias, numbness, and cold intolerance.…”

“…In addition, it is recommended that the patient also have either a positive Tinel’s sign, a positive response to local anesthetic injection, or confirmation of neuroma on ultrasound or MRI. 37 Use of these criteria may be helpful in determining eligibility for patients who may benefit from neuroma resection and intercalary PNA reconstruction to promote pain reduction and to allow for physiologic nerve regeneration.…”

Therapeutic Potential of Ultrasound Neuromodulation in Decreasing Neuropathic Pain: Clinical and Experimental Evidence

“…In medicine, ultrasound has been traditionally used as a diagnostic imaging tool [ 14 , 29 - 41 ]. It is also useful for procedure guidance in surgery, anesthesiology, interventional radiology, and several medical specialties [ 42 - 54 ].…”