In the extremities, a neuroma always forms after a nerve is cut, torn,
crushed or otherwise injured enough to divide any neuron fibers within the
nerve. Nerve cells sprout like roots from the near end of the nerve injury.
If these sprouts are contained within the nerve structure, some will find
their way out to the end of the nerve. However, the remainder grow into a
disorganized lump at the site of injury. This lump is the neuroma. A
neuroma may or may not be tender, depending on its location and the exact
nerve fibers involved. Some patients seem to be more prone than others to
pain and tenderness from neuromas. Nonoperative treatment options include
pain control and desensitization techniques. Surgical procedures may be
used to reposition a painful neuroma away from areas which have inadequate
padding, scar tethering, or poor blood supply. Postoperative desensitization
therapy is helpful, and ideally the patient should be able to demonstrate
skill at self desensitization techniques before having neuroma surgery.
Neuroma tenderness is usually improved immediately after surgery, but pain
may persist. In time, patients may develop recurrent symptoms, particularly
if they have failed prior surgery for neuroma. Amputation may be a last
resort for neuroma cripples, but has no guarantee of cure.
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