American Society for Peripheral Nerve
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Post-traumatic Chest Pain due to Neuroma of the Intercostal Nerves
Sofija Tusheva, MD; Gordana Georgieva, MD; Sofija Pejkova, MD PhD
University Clinic for Plastic and Reconstructive Surgery, Medical Faculty, University "St.Cyril and Methodius", Skopje, Macedonia, The former Yugoslav Republic of


Introduction:Pain that persists after trauma to the chest wall quite frequently is misdiagnosed. The cause of post-traumatic pain that is refractory to therapeutic modalities is very often a neuroma. Posttraumatic chest pain as a result of persisting neuroma of the intercostal nerves is a clinical entity that is frequently ignored and incorrectly diagnosed.
Materials and methods: We present three cases with post-traumatic intercostal neuroma. All of the patients were male and had a previous history of trauma to the chest wall (car accident, hematoma, fall). They have all seen different specialists to find the cause and to treat their chronic pain. Tinel's sign was positive along the lateral chest wall, and there was relief from the pain after a local anaesthetic block. The patients describe their pain as intense, sharp, stabbing, and burning. After a clinical examination, the surgery was scheduled. The surgical approach was planned according to the point of the positive Tinel sign and the reduction of pain after the application of local anaesthetic in the area of maximum sensitivity. After identifying the nerve, the neuromas were resected, and proximal dissection of the intercostal nerve was performed. Then the nerve was implanted in nearby muscles. The Visual Analogue Scale (VAS) was used to evaluate the levels of pain pre- and postoperatively.
Results: The mean age of the patients was 47 (range 36-62) Patients presented an average of 42 months after injury (range 12-84). Immediately postoperatively, all of the patients felt relief from pain. The preoperative VAS score average was 7.5, whereas the postoperative average value was 2 at the 6-month follow-up. The statistical difference is significant (p-value<0.05). One of the patients complained of discrete anaesthesia in part of the chest wall which afterwards disappeared entirely. No other complications were noted. The histopathological findings reveal neuromas.
Conclusion: Resection of neuromas of the intercostal nerve is likely to be a feasible option for patients with posttraumatic chest pain. Our results suggest that detailed and meticulous clinical investigations are crucial in patients with post-traumatic neuromas. Pain should not be underestimated; it is an essential part of the treatment algorithm. By applying this strategy to each of our patients, the chronic pain that afflicted them for years faded and disappeared.


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