Long-Term Outcomes after Surgical Treatment of Radial Sensory Nerve Neuromas: Patient-Reported Outcomes and Rate of Secondary Surgery

Abstract

Background: This study aimed to (1) describe long-term patient-reported outcomes of surgically treated symptomatic radial sensory nerve neuromas on function, pain interference, pain intensity, and satisfaction; (2) assess which factors were associated with worse function, higher pain intensity, and more pain interference; and (3) describe the secondary surgery rate and factors associated with secondary surgery. Methods: The authors conducted a retrospective review of patients surgically treated for radial sensory nerve neuroma from 2002 to 2016 (n = 54). Twenty-five of these 54 patients completed a follow-up survey including the Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity, pain interference, and depression scales; numerical rating scale pain and satisfaction instruments; and the global rating scale of change, at a mean period of 10.7 ± 4.3 years after neuroma surgery. Results: The mean PROMIS scores were 45.0 ± 12.1 for upper extremity, 55.5 ± 10.3 for pain interference, and 49.9 ± 10.2 for depression, and were within 1 SD of the general population. Eight patients (32 percent) reported symptoms as unchanged or worse following neuroma surgery. The median numerical rating scale pain was 3 (interquartile range, 1 to 6) and the global rating scale of change satisfaction was 10 (interquartile range, 7 to 10). Older patients (p = 0.002) and patients with higher PROMIS pain interference (p < 0.001), higher numerical rating scale for pain (p = 0.012), and lower global rating scale of change scores (p = 0.01) had worse PROMIS upper extremity scores. The secondary surgery rate was 20 percent and was associated with the presence of multiple neuromas (p = 0.001). Conclusions: Radial sensory nerve neuromas remain difficult to treat. They have a high secondary surgery rate (20 percent), with only 68 percent of patients reporting improvement after surgical intervention. Patient-reported outcomes after surgery are similar to conditions of the general population; however, the range of outcomes is wide.

Treatment of Refractory Radial Sensory Neuroma With Function-Sparing Targeted Muscle Reinnervation to the Extensor Carpi Radialis Brevis

“…If the entire ECRB muscle is denervated, the patient may experience radial wrist deviation on wrist extension or overall weakness with wrist extension; however, the ECRB is typically segmentally innervated by at least 2–4 motor branches, and native innervation is preserved if the most distal motor branch is selected as the target for the TMR. 16 …”

“…If the entire ECRB muscle is denervated, the patient may experience radial wrist deviation on wrist extension or overall weakness with wrist extension; however, the ECRB is typically segmentally innervated by at least 2e4 motor branches, and native innervation is preserved if the most distal motor branch is selected as the target for the TMR. 16 To find the RSN and motor branches to the ECRB in the proximal forearm, it is helpful to mark the skin incision before surgery with the patient fully awake (Fig. 1).…”

“…15 One study reported the rate of secondary surgery for RSN neuromas to be 20%, which is higher than that of other upper extremity neuromas. 16 Theoretically, the RSN can be transferred to any motor branch within reach to complete a successful TMR. In this paper, we present our surgical technique for the treatment of RSN neuromas with TMR to the expendable distal motor nerve to the extensor carpi radialis brevis (ECRB).…”

“… 15 One study reported the rate of secondary surgery for RSN neuromas to be 20%, which is higher than that of other upper extremity neuromas. 16 …”

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

“…Neuroma formation caused by peripheral nerve injury is a common and potentially debilitating condition associated with the disorganized growth and generation of hypersensitive nerve tissue. 1 Neuroma-related neuropathic pain may severely affect patient function and quality of life and can require multiple costly surgical interventions 2 due to high recurrence rates. 3 Often, pharmacologic intervention is unsuccessful, as 60%–70% of patients are unresponsive to symptomatic pain management techniques, 4 which supports the role of surgical reconstruction as a salvage treatment.…”