Neuroma

What is the condition?
A neuroma is a disorganized growth of nerve cells at the site of a nerve injury. A neuroma occurs after a nerve is partially or completely disrupted by an injury — either due to a cut, a crush or an excessive stretch. The neuroma is a ball-shaped mass at the site of the injury, which can be painful or cause a tingling sensation if tapped or if pressure is applied. Although not always the case, a neuroma can be extremely painful and can cause significant loss of function for the patient by limiting motion and contact with the affected area.

Most areas of the body have nerve fibers that provide feeling, so neuromas can occur after trauma or surgery in any region in the body. Painful neuromas are common after amputations of the hand, arm or leg. They are also common following hernia repair in the groin.

How are neuromas diagnosed?

Neuromas can be diagnosed by history and physical exam of patients. The areas of sensitivity are identified by tapping directly on known pathways for peripheral nerves, which should elicit the painful symptoms and often a tingling sensation (called a Tinel sign). These areas are then injected with a local anesthetic either at those sites or in the affected nerves (this is known as a nerve block). If relief is achieved, it is more likely that surgical treatment of that neuroma will help alleviate pain.

How are neuromas treated?

Surgical treatment of neuromas often involves resection of the involved nerve and either nerve reconstruction, burying of the nerve or targeted reinnervation (transferring an injured nerve to an uninjured nerve).  When a nerve stump is “buried,” it is placed in an area in the deeper tissues where it will not receive frequent direct stimulation from pressure or contact during normal activities. Medications are often used in conjunction with surgical treatment to modulate the body’s response to the neuroma pain, which can enhance the effects of surgery. Antidepressant medications and anti-seizure medicines are often prescribed for treatment prior to surgical correction as well. All treatment is performed in collaboration with a specialist in the treatment of chronic pain, and a multidisciplinary approach is often most helpful.