• Journal of neurosurgery · May 1993

    The surgical treatment of painful traumatic neuromas.

    • K J Burchiel, T J Johans, and J Ochoa.
    • Division of Neurosurgery, Oregon Health Sciences University, Portland.
    • J. Neurosurg. 1993 May 1;78(5):714-9.

    AbstractPain following suspected nerve injury was comprehensively evaluated with detailed examination including history, neurological evaluation, electrodiagnostic studies, quantitative sensory testing, thermography, anesthetic agents, and sympathetic nerve blocks. Forty-two surgically treated patients fell into four discrete groups: Group 1 patients had distal sensory neuromas treated by excision of the neuroma and reimplantation of the proximal nerve into muscle or bone marrow; Group 2 patients had suspected distal sensory neuromas in which the involved nerve was sectioned proximal to the injury site and reimplanted; Group 3 patients had proximal in-continuity neuromas of major sensorimotor nerves treated by external neurolysis; and Group 4 patients had proximal major sensorimotor nerve injuries at points of anatomical entrapment treated by external neurolysis and transposition, if possible. Patient follow-up monitoring from 2 to 32 months (average 11 months) was possible in 40 (95%) of 42 patients. Surgical success was defined as 50% or greater improvement in pain using the Visual Analog Scale or pain relief subjectively rated as either good or excellent, without postoperative narcotic usage. Overall, 16 (40%) of 40 patients met those criteria. Success rates varied as follows: 44% in 18 Group 1 patients, 40% in 10 Group 2 patients, 0% in five Group 3 patients, and 57% in seven Group 4 patients. Twelve (30%) of 40 patients were employed both pre- and postoperatively. It is concluded that: 1) neuroma excision, neurectomy, and nerve release for injury-related pain of peripheral nerve origin yield substantial subjective improvement in a minority of patients; 2) external neurolysis of proximal mixed nerves is ineffective in relieving pain; 3) surgically proving the existence of a neuroma with confirmed excision may be preferable; 4) traumatic neuroma pain is only partly due to a peripheral source; 5) demographic and neurological variables do not predict success; 6) the presence of a discrete nerve syndrome and mechanical hyperalgesia modestly predict pain relief; 7) ongoing litigation is the strongest predictor of failure; and 8) change in work status is not a likely outcome.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…

What will the 'Medical Journal of You' look like?

Start your free 21 day trial now.

We guarantee your privacy. Your email address will not be shared.