Treatment of End-Neuromas, Neuromas-in-Continuity and Scarred Nerves of the Digits by Proximal Relocation

Abstract

This paper reports the results of treatment by proximal relocation of 104 painful nerves in 57 digits in 48 patients. These included 86 digital nerves and 18 terminal branches of the superficial radial nerve and the dorsal branch of the ulnar nerve. Eighty-three were end-neuromas and 14 were neuromas-in-continuity, of which nine followed nerve repair and five occurred following a closed crush injury. Seven were painful as a result of tethering in scarred tissue. Eighty nerves (77%) required a single relocation and 24 (23%) required more than one operation. Ninety-eight per cent of nerve relocations achieved complete pain relief at the primary site. One patient had mild pain on pressure at the primary site after relocation of two nerves from this site. Over 90% of the nerves had no spontaneous pain, pain on movement or hypersensitivity of the overlying skin at the final site of relocation. However, the incidence of mild or no pain on direct pressure at the site of nerve relocation was lower at 83% as relocated nerves, although traumatized less often at the sites chosen for relocation, can still be painful on direct pressure.

Neuropathic Pain in Patients with Upper-Extremity Nerve Injury

“…While pain questionnaires and rating scales (verbal and numeric) can assess the intensity, quality, and frequency of pain and are often used in the surgical literature, [105][106][107][108][109][110][111][112][113][114][115][116][117][118][119][120] these types of measures do not evaluate the psychosocial factors that are often associated with neuropathic pain. The European Federation of Neurological Societies has presented guidelines for the assessment of neuropathic pain; 1 a baseline assessment can be achieved with NRS, VRS, or VAS, and more in-depth assessment can include pain descriptors, temporal factors, and functional impact.…”

Treatment by collagen conduit of painful post-traumatic neuromas of the sensitive digital nerve: A retrospective study of 10 cases

“…If function in the injured nerve is not critical, the distal nerve stump is not available (i.e., amputation neuroma), or the tissue bed and local environment are not suitable for nerve grafting, then the neuroma is resected and the proximal nerve is transposed into an area that is subjected to minimal mechanical stimulation. Many treatment modalities have been described, such as transfer into bone [5], muscle [6][7][8], or vein [9]. Treatment of the proximal stump with electrical coagulation, chemical agents (alcohol, phenol) or suture ligation has also been reported [10].…”

Relocation of Neuromas of the Lateral Antebrachial Cutaneous Nerve of the Forearm Into the Brachialis Muscle

“…Implantation of neuromas into muscle was described as early as 1918 (Moszkowicz, 1918) although the techniques of relocation have been refined to identify muscles appropriate for nerve relocation in specific anatomical areas (Dellon and Mackinnon, 1986;Dellon et al, 2004;Hazari and Elliot, 2004;Novak et al, 1995;Sood and Elliot, 1998;Stahl and Rosenberg, 2002). For reasons already described, the superficial radial nerve and the lateral antebrachial cutaneous nerve are both frequently injured and synchronous relocation of the two nerves into the brachioradialis muscle is often appropriate (Dellon and Mackinnon, 1986).…”