gms | German Medical Science

Objectives/Interrogation: To report the outcome of neuromodulation as an outpatient, non-invasive therapy for painful cutaneous neuromas

Methods: This was a retrospective review of a consecutive series of patients who presented with a painful cutaneous neuroma secondary to a direct trauma or surgery. The diagnosis was made by the presence of neuropathic symptoms in the dermatome of a cutaneous nerve and a positive Tinel sign. Local anaesthetic injection was performed for confirmation of diagnosis. NCS was requested only if there were diagnostic doubts or to exclude superimposed entrapment neuropathy. Each patient was offered optimisation of medical therapy and physiotherapy for scar desensitisation. Neuromodulation was offered as an alternative to neuroma surgery. A course of neuromodulation typically involved six weekly outpatient visits, supervised by a trained nurse. The primary aim of treatment was symptom reduction such that neuroma surgery was no longer required.

Results: Between October 2015 and June 2018, 50 patients (25 females, 25 males) with a mean age of 47 years (range 18-79) presented with a painful cutaneous neuroma. The nerves injured in the order of frequency were superficial radial nerve (16), digital nerve (8), dorsal ulnar cutaneous nerve (7), palmar cutaneous branch of median (4), saphenous nerve (4), sural nerve (2), lateral femoral cutaneous nerve (2), medial antebrachial cutaneous nerve (2), lateral antebrachial cutaneous nerve (2), superficial peroneal nerve (1), posterior cutaneous branch of radial nerve (1) and supraclavicular nerve (1).

3 cases were due to a dog bite, 9 were due to direct trauma and 38 were due to an operation. The index operations included De Quervain release, trapeziectomy, UCL reconstruction, wrist arthroscopy, elbow arthroscopy, carpal tunnel release, cubital tunnel release, ray amputation, distal radius plating, metacarpal plating, CMCJ fusion, trigger finger release and wrist fusion; pelvic surgery, ankle arthroscopy, knee arthroscopy, TKR, high tibial osteotomy, femoropopliteal bypass and Achilles tendon repair.

18 (36%) patients had sufficient symptom relief after neuromodulation such that they did not need to pursue neuroma surgery.

Conclusions: Surgery is the commonest cause of a painful cutaneous neuroma. Neuromodulation may offer symptom relief such that neuroma surgery may be avoided in a third of cases. It is a safe and effective therapy for painful cutaneous neuromas.