American Society for Peripheral Nerve
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Think of Neuromas- Pain as an Important Diagnostic Tool
Stefania Azmanova Mladenovska, MD; Bisera Nikolovska, MD PhD; Blagoja Srbov, MD
University Clinic for Plastic and Reconstructive Surgery, Medical Faculty, University "St.Cyril and Methodius", Skopje, Macedonia, The former Yugoslav Republic of

Introduction: Traumatic injuries of nerves, if not treated primarily may result in neuroma formation. The aim of this paper is to emphasize the importance of pain when diagnosing patients with previous trauma.
Materials & Methods: A retrospective medical record review of three patients diagnosed and surgically treated for neuroma was conducted at our clinic. Patientsí charts were reviewed for medical history, etiology of neuroma, and treatment outcomes. Diagnosis of neuroma was clinically characterized by pain associated with scar, altered sensation within the given nerve distribution, and a positive Tinel sign. Diagnostic tests such as The Dellon-McKinnon test in correlation with Visual Analog Scale (VAS) for pain were used to confirm the presence of symptomatic end-neuroma. VAS and Patient-Reported Outcomes Measurement Information System (PROMIS) upper-extremity module 8a scores were used to determine the quality of life before and 6 months after surgical treatment. The average patient follow up was 12 months.
Results: The etiologies for neuroma were iatrogenic (during osteosynthesis of the humerus, the radial nerve was injured) and traumatic (multi-digit amputation of the index and third finger with injury of digital nerves and laceration of forearm with overlooked injury of median and ulnar nerve). The patients developed the following pathological entities: scar-tethered nerves, end neuroma and neuroma in continuity, respectively. Surgical treatment was performed in accordance with the recommended guidelines for treatment of the different pathological entities; resection of neuroma with sural nerve graft, resection of neuroma with implantation of the nerve into the muscle and neurolysis of the nerve, respectively. The average PROMIS T score before surgical treatment was 67.3 reflecting substantial problems with pain. The average T score after surgical treatment was 52.5 reflecting minimal pain. The average VAS before surgical treatment was 8.1. At 6 months follow-up, the average VAS was 1.4 points. All three patients presenting with neuroma pain experienced considerable reduction of pain, and spontaneous pain disappeared.
Conclusion: The description of the pain and sensations, can be quite debilitating and painful, often preventing patients from continuing with their normal daily activities. Diagnosis and referral of neuroma patients without delay to a plastic surgeon is important, because the symptoms become progressively difficult to treat over time.


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