Management of a Painful Neuroma

C.Y. Ng Consultant Hand & Peripheral Nerve Surgeon

Wrightington Hospital

Overview

• What is pain?• Non-surgical treatment of a painful neuroma• Surgical treatment of a painful neuroma• Case discussion

Decision Making

• Which nerve is involved?• What type of nerve? Sensory / motor / mixed• Is the nerve cut or in-continuity?• Is the nerve sacrificable? Pain vs function• What is patient’s (surgeon’s) expectation?

Treatment Targets

Surgical Options

• Neurolysis +/- wrapping• Nerve repair / grafting• Nerve burial / relocation• Nerve transfer

Surgical Principles

• Move it out of harm’s way!

• Give the nerve something to do!

Conclusions

• Painful neuroma – Challenging condition

• Can be very rewarding & frustrating to treat

• Multi-disciplinary & multi-modality approach