Patient reported symptoms and disabilities before and after neuroma surgery: a register-based study

Abstract

Residual problems may occur from neuroma despite surgery. In a 12-month follow-up study using national register data, symptoms, and disabilities related to surgical methods and sex were evaluated in patients surgically treated for a neuroma. Among 196 identified patients (55% men; lower age; preoperative response rate 20%), neurolysis for nerve tethering/scar formation was the most used surgical method (41%; more frequent in women) irrespective of affected nerve. Similar preoperative symptoms were seen in patients, where different surgical methods were performed. Pain on load was the dominating symptom preoperatively. Women scored higher preoperatively at pain on motion without load, weakness and QuickDASH. Pain on load and numbness/tingling in fingers transiently improved. The ability to perform daily activities was better after nerve repair/reconstruction/transposition than after neurolysis. Regression analysis, adjusted for age, sex, and affected nerve, showed no association between surgical method and pain on load, tingling/numbness in fingers, or ability to perform daily activities. Neuroma, despite surgery, causes residual problems, affecting daily life. Choice of surgical method is not strongly related to pre- or postoperative symptoms. Neurolysis has similar outcome as other surgical methods. Women have more preoperative symptoms and disabilities than men. Future research would benefit from a neuroma-specific ICD-code, leading to a more precise identification of patients.

Figure 1

Flowchart illustrating identified patients that were diagnosed and surgically treated for a neuroma in the upper limb in the national registry for hand surgery (hakir.se) and evaluated for the study. ^aFor ICD codes and used surgical codes see “Materials and methods”.

Figure 2

Spider diagrams showing the outcome of neuroma surgery among (a) all responders and (b) eight patients responding at all three time points. Data are based on the HQ-8 questionnaire consisting of eight specific questions and the total score of the QuickDASH questionnaire. HQ-8 questions are an abbreviation of HAKIR Questionnaire 8. QuickDASH stands for the shortened disabilities of the arm, shoulder and hand questionnaire. HQ-8 questions and total QuickDASH score evaluated preoperatively. 0 is no problems and 100 is worst case scenario.