Surgical Management of Neuromas of the Hand and Wrist

Steven Regal, MD; Peter Tang, MD, MPH

Disclosures

J Am Acad Orthop Surg. 2019;27(10):356-363. 

In This Article

Abstract and Introduction

Abstract

Neuromas of the hand and wrist are common causes of peripheral nerve pain. Neuromas are formed after the nerve sustains an injury, and they can be debilitating and painful. The diagnosis is made by a thorough history and physical examination. The treatment options are quite varied, but conservative measures tailored to the patient should be initiated first. No surgical treatment has been proven superior to others or to nonsurgical treatment.

Introduction

Neuromas of the hand and wrist can be a mentally and physically disabling condition for patients. A neuroma is the abnormal growth of nerve tissue that consists of a disorganized architecture of axons, Schwann cells, macrophages, and fibroblasts as a result of the biologic response to nerve trauma or an unsuccessful nerve repair (Figure 1). Neuroma formation may result secondary to a peripheral nerve injury, such as a laceration, crush injury, chronic irritation or stretch, or the result of a nerve repair. Patients who experience a digit amputation have a reported 2.7% to 30% incidence of developing a symptomatic neuroma.[1,2] In a nerve injury where the axon is disrupted, the distal portion of the axon will undergo Wallerian degeneration. The proximal portion of the neuron sprouts toward the empty neural tube and will grow 1 to 2 mm per day to restore the nerve's function. A neuroma will form if the proximal neuron fails to effectively reach the distal nerve end.[3,4] With more than 150 different treatment options for symptomatic neuromas, the optimal management remains unknown and hence, the challenge. This article reviews the nonsurgical and surgical management of symptomatic neuromas of the hand and wrist.

Figure 1.

Electron microscopic image of peripheral nerve (A). Electron microscopic image of neuroma showing hypertrophic nerves with perineural fibrosis (B).

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