Neuromas cause severe residual problems at long-term despite surgery

Abstract

Pain, and disabilities after neuroma surgery, using patient reported outcome measurements (PROMs), were evaluated by QuickDASH and a specific Hand Questionnaire (HQ-8). The 69 responding individuals (response rate 61%; 59% women; 41% men; median follow up 51 months) reported high QuickDASH score, pain on load, cold sensitivity, ability to perform daily activities and sleeping difficulties. Individuals reporting impaired ability to perform daily activities and sleeping problems had higher scores for pain, stiffness, weakness, numbness/tingling, cold sensitivity and QuickDASH. Only 17% of individuals reported no limitations at all. No differences were observed between sexes. Surgical methods did not influence outcome. Symptoms and disabilities correlated moderately-strongly to each other and to ability to perform regular daily activities as well as to sleeping difficulties. Pain, cold sensitivity, sleeping difficulties and limitation to perform daily activities were associated to higher QuickDASH. A weak association was found between follow up time and QuickDASH score as well as pain on load, but not cold sensitivity. A major nerve injury was frequent among those with limitations during work/performing other regular daily activities. Despite surgical treatment, neuromas cause residual problems, which affect the capacity to perform daily activities and ability to sleep with limited improvement in long-term.

Patient reported symptoms and disabilities before and after neuroma surgery: a register-based study

“…In agreement, surgery among the patients in our study had no great impact on the symptoms and disabilities with only a small and possibly transient improvement in pain on load and numbness/tingling in fingers during the 12-month follow-up. Interestingly, the evaluated symptoms and disabilities, using the same questionnaires as in the present study, may essentially remain in 114 patients surgically treated for neuroma at a follow-up study with a median of 51 months postoperatively, except that pain at rest and pain on motion without load may show some improvement over time 24 .…”

“…In addition, there is a need to use PROMs with specific questions concerning pain modalities 18 , 44 with the intention of future development of the procedures in neuroma surgery. A strength of the present study is the defined follow-up time (rather precisely three and 12 months), which differs from other published articles 6 , 24 , 29 , 45 .…”

“…The present data indicate that the preoperative symptoms and disability were similar between the patients treated with neurolysis and nerve repair/reconstruction/transposition, which may indicate that the indication for surgery was similar for the two surgical groups. Data from a national register study can utilize the individual patient's preoperative symptoms and disabilities in contrast to retrospective studies 6 , 15 , 24 , 29 .…”

Socioeconomic factors and outcome after repair and reconstruction of digital and major nerve trunk injuries in the upper limb

“…Psychosocial factors, including depression, coping strategies, and anxiety, can influence outcome, like pain level, patient satisfaction, and disability 36 . The observed disparities in individuals with CTS are unrelated to psychological health or an increased risk of using painkillers, such as opioids 10 , 11 . Whether men with a major nerve trunk injury have poorer psychological health and higher risk of psychotropic or analgesic drug use is unknown.…”

“…Digital nerves, more commonly affecting men 6 , 7 , are more frequently injured than the median and ulnar nerves 8 , 9 . A severe pain condition after a nerve injury may necessitate not only surgical intervention but also pharmacological treatment, carrying the risk of side effects and potential drug dependence, further burdening individuals, and society 10 , 11 . Disabling and persistent pain can affect the individual’s physical and mental health with reduced quality of life, depression, and suicide risk 12 , 13 .…”