Neuroma

Excerpt

Neuromas are benign nodular tumors that arise from a nerve. Neuromas are non-neoplastic masses of connective tissue, Schwann cells, and regenerated axons that can develop anywhere in the body. Although there are various types of neuromas, the term most commonly refers to traumatic neuromas, which develop as an injured nerve starts to heal in an uncontrolled manner, resulting in a lump of unorganized axon fibers and non-neural tissue growth. Traumatic neuromas can be caused by any type of nerve injury, including surgical trauma, blunt force trauma, nerve transection, or chronic inflammation. Traumatic neuromas also can be subtyped further based on whether the nerve segments are connected (ie, neuroma-in-continuity), remain separated (ie, end-neuroma), or are entrapped within scar tissue. Other neuromas can occur secondary to syndromes (eg, neurofibromatosis) or true neoplastic processes (eg, acoustic neuroma or Morton neuroma).

Diagnosis of traumatic neuromas is initially made by clinical assessment with diagnostic imaging studies performed to evaluate the location and severity of nerve injury. The characteristic clinical presentation consists of a history or source of injury followed by the gradual development of a firm, ovoid palpable mass, typically less than 2 cm in size, with pain symptoms. The pain caused by neuromas is commonly described as stiffness, hypersensitivity, burning, tingling, or sharpness. Traumatic neuroma treatment consists of surgical and nonsurgical management, including physiotherapy, medications, and high-frequency electrical stimulation. A strong emphasis on prevention, meaning surgical exploration and repair of nerve injuries promptly after the initial injury occurs.