Pathogenesis, clinical evaluation and non-surgical management of symptomatic neuromas: A literature review

Abstract

Neuromas are an often-underdiagnosed cause of chronic pain resulting from a peripheral nerve injury. There are two main sub-types as follows: end neuromas result from nerve transection caused by transection of a nerve due to trauma, iatrogenic injury, following amputation or oncological resection and neuroma-in-continuity where axonal injury with loss of internal neural architecture following direct trauma, compression or traction results in disorganised neural regeneration with no loss of physical continuity of the nerve sheath. Pharmacological symptom control is often inadequate. A comprehensive, structured assessment and multi-modality management regimen is required to achieve favourable outcomes in neuroma management. Strategies include peripheral neuromodulation, neurorehabilitation interventions, psychological support, peripheral nerve blockade, radiofrequency ablation and surgery. Surgical interventions are aimed at restoration of nerve continuity when possible, modification of the nerve environment and neuroma relocation or capping. This review will discuss diagnostic techniques and management strategies of peripheral neuromas.