Outcomes of the surgical treatment of peripheral neuromas of the hand and forearm: A 25-year comparative outcome study

Darlene Michele Guse, Steven Lawrence Moran

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

PURPOSE: Peripheral neuromas within the upper extremity result in significant disability. Treatment options vary, and established protocols have yet to be determined. We performed a long-term outcome comparison examining different treatment options for peripheral upper extremity neuromas to determine which method provided superior results using a validated upper extremity outcome measurement system. METHODS: A retrospective chart review was performed for all patients undergoing surgical intervention from 1980 to 2005 for a symptomatic neuroma of the hand or forearm. Patients' charts were reviewed for medical history, etiology of neuroma, and treatment outcomes. Patients were surveyed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and pain evaluation questionnaires. RESULTS: We identified 127 eligible patients who had their index procedure performed at our institution. Fifty-six patients completed the questionnaires. In all cases, verification of a neuroma was made on pathologic and surgical examination. Follow-up averaged 240 months from the time of surgery. Mean age at the time of surgery was 40 years (range, 19-72 years). Of all the patients, 11 were treated with muscle or bone transposition, 17 with simple excision, and 28 with nerve repair and neurolysis. Mean DASH score at the final follow-up was 19.75 (range, 0-78.3). Patients who underwent neuroma excision with nerve repair had significantly lower postoperative DASH scores, averaging 11.42, compared with either muscle or bone transposition or simple excision (mean DASH score, 22.4 and 32.0, respectively, P = 0.01). The number of neuroma procedures (P = 0.04), preoperative pain severity (P = 0.03), and postoperative pain severity (P = 0.04) all affected the final DASH score. Fifteen patients (27%) required more than 1 surgery. Simple neuroma excision resulting in the highest incidence of reoperations (47%). CONCLUSIONS: Treatment of upper extremity neuromas remains a complicated problem. Within this study, nerve repair yielded improved DASH scores compared with nerve transposition or the use of simple resection. Resection alone was associated with an unacceptable recurrence rate and should be discouraged as treatment for upper extremity neuromas. Prior surgical procedures, neuroma size, and the severity of preoperative pain may all adversely impact the success of surgical intervention.

Original languageEnglish (US)
Pages (from-to)654-658
Number of pages5
JournalAnnals of Plastic Surgery
Volume71
Issue number6
DOIs
StatePublished - Dec 2013

Fingerprint

Neuroma
Forearm
Hand
Outcome Assessment (Health Care)
Upper Extremity
Arm
Pain
Bone and Bones
Muscles
Therapeutics
Postoperative Pain
Reoperation

Keywords

  • DASH
  • forearm
  • hand
  • nerve
  • neuroma

ASJC Scopus subject areas

  • Surgery

Cite this

Outcomes of the surgical treatment of peripheral neuromas of the hand and forearm : A 25-year comparative outcome study. / Guse, Darlene Michele; Moran, Steven Lawrence.

In: Annals of Plastic Surgery, Vol. 71, No. 6, 12.2013, p. 654-658.

Research output: Contribution to journalArticle

@article{2a9ffe6a83cb4eda833c4f094d021116,
title = "Outcomes of the surgical treatment of peripheral neuromas of the hand and forearm: A 25-year comparative outcome study",
abstract = "PURPOSE: Peripheral neuromas within the upper extremity result in significant disability. Treatment options vary, and established protocols have yet to be determined. We performed a long-term outcome comparison examining different treatment options for peripheral upper extremity neuromas to determine which method provided superior results using a validated upper extremity outcome measurement system. METHODS: A retrospective chart review was performed for all patients undergoing surgical intervention from 1980 to 2005 for a symptomatic neuroma of the hand or forearm. Patients' charts were reviewed for medical history, etiology of neuroma, and treatment outcomes. Patients were surveyed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and pain evaluation questionnaires. RESULTS: We identified 127 eligible patients who had their index procedure performed at our institution. Fifty-six patients completed the questionnaires. In all cases, verification of a neuroma was made on pathologic and surgical examination. Follow-up averaged 240 months from the time of surgery. Mean age at the time of surgery was 40 years (range, 19-72 years). Of all the patients, 11 were treated with muscle or bone transposition, 17 with simple excision, and 28 with nerve repair and neurolysis. Mean DASH score at the final follow-up was 19.75 (range, 0-78.3). Patients who underwent neuroma excision with nerve repair had significantly lower postoperative DASH scores, averaging 11.42, compared with either muscle or bone transposition or simple excision (mean DASH score, 22.4 and 32.0, respectively, P = 0.01). The number of neuroma procedures (P = 0.04), preoperative pain severity (P = 0.03), and postoperative pain severity (P = 0.04) all affected the final DASH score. Fifteen patients (27{\%}) required more than 1 surgery. Simple neuroma excision resulting in the highest incidence of reoperations (47{\%}). CONCLUSIONS: Treatment of upper extremity neuromas remains a complicated problem. Within this study, nerve repair yielded improved DASH scores compared with nerve transposition or the use of simple resection. Resection alone was associated with an unacceptable recurrence rate and should be discouraged as treatment for upper extremity neuromas. Prior surgical procedures, neuroma size, and the severity of preoperative pain may all adversely impact the success of surgical intervention.",
keywords = "DASH, forearm, hand, nerve, neuroma",
author = "Guse, {Darlene Michele} and Moran, {Steven Lawrence}",
year = "2013",
month = "12",
doi = "10.1097/SAP.0b013e3182583cf9",
language = "English (US)",
volume = "71",
pages = "654--658",
journal = "Annals of Plastic Surgery",
issn = "0148-7043",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Outcomes of the surgical treatment of peripheral neuromas of the hand and forearm

T2 - A 25-year comparative outcome study

AU - Guse, Darlene Michele

AU - Moran, Steven Lawrence

PY - 2013/12

Y1 - 2013/12

N2 - PURPOSE: Peripheral neuromas within the upper extremity result in significant disability. Treatment options vary, and established protocols have yet to be determined. We performed a long-term outcome comparison examining different treatment options for peripheral upper extremity neuromas to determine which method provided superior results using a validated upper extremity outcome measurement system. METHODS: A retrospective chart review was performed for all patients undergoing surgical intervention from 1980 to 2005 for a symptomatic neuroma of the hand or forearm. Patients' charts were reviewed for medical history, etiology of neuroma, and treatment outcomes. Patients were surveyed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and pain evaluation questionnaires. RESULTS: We identified 127 eligible patients who had their index procedure performed at our institution. Fifty-six patients completed the questionnaires. In all cases, verification of a neuroma was made on pathologic and surgical examination. Follow-up averaged 240 months from the time of surgery. Mean age at the time of surgery was 40 years (range, 19-72 years). Of all the patients, 11 were treated with muscle or bone transposition, 17 with simple excision, and 28 with nerve repair and neurolysis. Mean DASH score at the final follow-up was 19.75 (range, 0-78.3). Patients who underwent neuroma excision with nerve repair had significantly lower postoperative DASH scores, averaging 11.42, compared with either muscle or bone transposition or simple excision (mean DASH score, 22.4 and 32.0, respectively, P = 0.01). The number of neuroma procedures (P = 0.04), preoperative pain severity (P = 0.03), and postoperative pain severity (P = 0.04) all affected the final DASH score. Fifteen patients (27%) required more than 1 surgery. Simple neuroma excision resulting in the highest incidence of reoperations (47%). CONCLUSIONS: Treatment of upper extremity neuromas remains a complicated problem. Within this study, nerve repair yielded improved DASH scores compared with nerve transposition or the use of simple resection. Resection alone was associated with an unacceptable recurrence rate and should be discouraged as treatment for upper extremity neuromas. Prior surgical procedures, neuroma size, and the severity of preoperative pain may all adversely impact the success of surgical intervention.

AB - PURPOSE: Peripheral neuromas within the upper extremity result in significant disability. Treatment options vary, and established protocols have yet to be determined. We performed a long-term outcome comparison examining different treatment options for peripheral upper extremity neuromas to determine which method provided superior results using a validated upper extremity outcome measurement system. METHODS: A retrospective chart review was performed for all patients undergoing surgical intervention from 1980 to 2005 for a symptomatic neuroma of the hand or forearm. Patients' charts were reviewed for medical history, etiology of neuroma, and treatment outcomes. Patients were surveyed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and pain evaluation questionnaires. RESULTS: We identified 127 eligible patients who had their index procedure performed at our institution. Fifty-six patients completed the questionnaires. In all cases, verification of a neuroma was made on pathologic and surgical examination. Follow-up averaged 240 months from the time of surgery. Mean age at the time of surgery was 40 years (range, 19-72 years). Of all the patients, 11 were treated with muscle or bone transposition, 17 with simple excision, and 28 with nerve repair and neurolysis. Mean DASH score at the final follow-up was 19.75 (range, 0-78.3). Patients who underwent neuroma excision with nerve repair had significantly lower postoperative DASH scores, averaging 11.42, compared with either muscle or bone transposition or simple excision (mean DASH score, 22.4 and 32.0, respectively, P = 0.01). The number of neuroma procedures (P = 0.04), preoperative pain severity (P = 0.03), and postoperative pain severity (P = 0.04) all affected the final DASH score. Fifteen patients (27%) required more than 1 surgery. Simple neuroma excision resulting in the highest incidence of reoperations (47%). CONCLUSIONS: Treatment of upper extremity neuromas remains a complicated problem. Within this study, nerve repair yielded improved DASH scores compared with nerve transposition or the use of simple resection. Resection alone was associated with an unacceptable recurrence rate and should be discouraged as treatment for upper extremity neuromas. Prior surgical procedures, neuroma size, and the severity of preoperative pain may all adversely impact the success of surgical intervention.

KW - DASH

KW - forearm

KW - hand

KW - nerve

KW - neuroma

UR - http://www.scopus.com/inward/record.url?scp=84885308271&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84885308271&partnerID=8YFLogxK

U2 - 10.1097/SAP.0b013e3182583cf9

DO - 10.1097/SAP.0b013e3182583cf9

M3 - Article

C2 - 22868319

AN - SCOPUS:84885308271

VL - 71

SP - 654

EP - 658

JO - Annals of Plastic Surgery

JF - Annals of Plastic Surgery

SN - 0148-7043

IS - 6

ER -