Neuroma: Difference between revisions

Jump to navigation Jump to search
mNo edit summary
mNo edit summary
Line 7: Line 7:
==Overview==
==Overview==


'''Neuroma''' (''Neuro-'' is from the Greek for ''nerve'') is defined as a [[benign tumor]] of a [[nerve]]. However, neuroma commonly refers to any [[tumor]] of cells of the [[nervous system]].<ref name="Dorlands">{{cite encyclopedia|editor= |encyclopedia=Dorland's Illustrated Medical Dictionary| edition=32nd| title=Neuroma | url=http://books.google.com/books?id=mNACisYwbZoC&pg=PT5287|accessdate=25 August 2013| year=2011| publisher=Oxford University Press| isbn=978-1-4557-0985-4 |page=5287}}</ref> Neuromas form part of the [[peripheral nerve]] sheath tumors. Neuroma was first described by Thomas Morton in 1876. Neuromas may be classified according to histopathological features into 3 groups: Morton's neuroma, traumatic neuroma, and neoplasic neuromas. The pathogenesis of neuroma is characterized by neural degeneration with epineural and endoneural vascular hyalinization, and perineural fibrosis. Neuroma is more commonly observed among patients aged between 15 to 50 years old. Neuroma is more commonly observed among middle aged adults. Females are more commonly affected with neuroma than males. The female to male ratio is approximately 5:1. Common risk factors in the development of neuroma, include: unproper footwear and high impact sports (eg. rock-climbing, ballet dancing). The most important complication of neuroma is chronic neuropathic pain. On ultrasound, neuroma is characterized as a well-defined, hypoechoic lesion, and located in the intermetatarsal space proximal to the metatarsal head. Patients with neuroma usually appear with antalgic posture. Physical examination may be remarkable for: Tenderness to palpation and dysesthetic pain. Surgical excision is the treatment of choice for patients with neuroma with a relatively good success rate, around 80%. The recurrence rate after surgery is as high as 50%
'''Neuroma''' (''Neuro-'' is from the Greek for ''nerve'') is defined as a [[benign tumor]] of a [[nerve]]. However, neuroma commonly refers to any [[tumor]] of cells of the [[nervous system]].<ref name="Dorlands">{{cite encyclopedia|editor= |encyclopedia=Dorland's Illustrated Medical Dictionary| edition=32nd| title=Neuroma | url=http://books.google.com/books?id=mNACisYwbZoC&pg=PT5287|accessdate=25 August 2013| year=2011| publisher=Oxford University Press| isbn=978-1-4557-0985-4 |page=5287}}</ref> Neuromas form part of the [[peripheral nerve]] sheath tumors. Neuroma was first described by Thomas Morton in 1876. Neuromas may be classified according to histopathological features into 3 groups: Morton's neuroma, traumatic neuroma, and neoplasic neuromas. The pathogenesis of neuroma is characterized by neural degeneration with epineural and endoneural vascular [[hyaline|hyalinization]], and perineural fibrosis. Neuroma is more commonly observed among patients aged between 15 to 50 years old. Neuroma is more commonly observed among middle aged adults. Females are more commonly affected with neuroma than males. The female to male ratio is approximately 5:1. Common risk factors in the development of neuroma include improper footwear and high impact sports (e.g., rock-climbing, ballet dancing). A major complication of neuroma is chronic neuropathic pain. On ultrasound, neuroma is characterized as a well-defined, hypoechoic lesion located in the intermetatarsal space proximal to the metatarsal head. Patients with neuroma usually appear with antalgic posture. Physical examination may be remarkable for tenderness to palpation and dysesthetic pain. Surgical excision is the treatment of choice for patients with neuroma; this surgical intervention is associated with a relatively favorable success rate, approximately 80%. The recurrence rate after surgery is as high as 50%.


==Historical Perspective==
==Historical Perspective==
*Neuroma was first described by Thomas Morton in 1876
Neuroma was first described by Thomas Morton in 1876.


==Classification==
==Classification==
Line 18: Line 18:
::*Also known as Morton’s metatarsalgia
::*Also known as Morton’s metatarsalgia
:*'''Traumatic neuroma'''
:*'''Traumatic neuroma'''
::*Arises from nerve injury (often as a result of surgery).
::*Arises from nerve injury (often as a result of surgery)
::*They occur at the end of injured nerve fibres as a form of uneffective, unregulated nerve regeneration
::*They occur at the end of injured nerve fibers as a form of unregulated nerve regeneration
::*Subtype of traumatic neuroma, called "Joplin neuroma" (a compression traumatic neuroma)
::*Subtype of traumatic neuroma, called "Joplin neuroma" (a compression traumatic neuroma)
::*Occurs most commonly near a [[scar]]
::*Occurs most commonly near a [[scar]]
Line 28: Line 28:


==Pathophysiology==
==Pathophysiology==
*The pathogenesis of neuroma is characterised by neural degeneration with epineural and endoneural vascular hyalinization, and perineural fibrosis.<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*The pathogenesis of neuroma is characterized by neural degeneration with epineural and endoneural vascular hyalinization, and perineural fibrosis.<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*The pathogenesis of traumatic neuroma is characterised by a chronic reactive fibroinflammatory disorganised regeneration around a nerve after an injury (such as traction injury or chronic repetitive stress)
*The pathogenesis of traumatic neuroma is characterized by a chronic reactive fibroinflammatory disorganized regeneration around a nerve after an injury (such as traction injury or chronic repetitive stress).
*Morton neuroma is characterized by being located in the 3rd web-space, between 3rd and 4th [[Metatarsals|metatarsal]] heads.  
*Morton neuroma is characterized by being located in the 3rd web-space, between 3rd and 4th [[Metatarsals|metatarsal]] heads.  
*Another subtype of traumatic neuroma is terminal neuroma (also known as "stump neuroma") which can occur after transection of the nerve (e.g. limb amputation).  
*Another subtype of traumatic neuroma is terminal neuroma (also known as "stump neuroma") which can occur after transection of the nerve (e.g. limb [[amputation]]).  
*The are no genetic mutations associated with the development of neuroma.  
*The are no genetic mutations associated with the development of neuroma.  
*On gross pathology, characteristic findings of neuroma, include:<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
*On gross pathology, characteristic findings of neuroma, include:<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
Line 41: Line 41:
:*[[Thrombosis]]
:*[[Thrombosis]]
:*Arterial thickening
:*Arterial thickening
*The image below demonstrates microscopic histopathological analysis of traumatic neuroma  
*The image below demonstrates microscopic histopathological analysis of traumatic neuroma:
<gallery>
<gallery>
Image:Traumatic neuroma.jpg| Traumatic neuroma<SMALL> Courtesy of Libre Pathology</SMALL>
Image:Traumatic neuroma.jpg|Traumatic neuroma. Courtesy of Libre Pathology
</gallery>
</gallery>
==Causes==
==Causes==
*Common causes of neuroma, include:<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
*Common causes of neuroma include:<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
:*Indirect nerve trauma
:*Indirect nerve trauma
::*Traction injury  
::*Traction injury  
Line 52: Line 52:


==Differentiating Neuroma  from other Diseases==
==Differentiating Neuroma  from other Diseases==
*Neuroma must be differentiated from other diseases that cause forefoot pain, and numbness, such as:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
*Neuroma must be differentiated from other diseases that cause forefoot pain and numbness such as:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref><ref name="pmid10597831">{{cite journal |vauthors=Wu J, Chiu DT |title=Painful neuromas: a review of treatment modalities |journal=Ann Plast Surg |volume=43 |issue=6 |pages=661–7 |year=1999 |pmid=10597831 |doi= |url=}}</ref>
:*[[Stress fracture]] (neck of the metatarsal)
:*[[Stress fracture]] (neck of the metatarsal)
:*[[Rheumatoid arthritis]]  
:*[[Rheumatoid arthritis]]  
Line 73: Line 73:


==Risk Factors==
==Risk Factors==
*Common risk factors in the development of neuroma, include:<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref>
*Common risk factors in the development of neuroma include:<ref name="wiki">Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016</ref>
:*Unproper footwear
:*Improper footwear
:*High impact sports (eg. rock-climbing, ballet dancing)
:*High-impact sports (e.g., rock-climbing, ballet dancing)


== Natural History, Complications and Prognosis==
== Natural History, Complications and Prognosis==
*The majority of patients with neuroma are symptomatic at the time of diagnosis.<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*The majority of patients with neuroma are symptomatic at the time of diagnosis.<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*Early clinical features include neuropathic pain, or local tenderness.
*Early clinical features include neuropathic pain or local [[tenderness]].
*If left untreated, the majority of patients with neuroma may progress to develop walking difficulty, and limping.  
*If left untreated, the majority of patients with neuroma may progress to develop [[difficulty walking]] and [[limping]].  
*The most important complication of neuroma is chronic [[neuropathic pain]].  
*A significant complication of neuroma is chronic [[neuropathic pain]].  
*Prognosis is generally good, and the survival rate of patients with neuroma is 99%.
*Prognosis is generally good, and the survival rate of patients with neuroma is 99%.


Line 87: Line 87:
=== Symptoms ===
=== Symptoms ===
*Neuroma  is usually asymptomatic.
*Neuroma  is usually asymptomatic.
*Symptoms of neuroma may include the following:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*Symptoms of neuroma may include:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
:*Focal area of neuropathic pain  
:*Focal area of neuropathic pain  
::*No alleviating factors  
::*No alleviating factors  
Line 95: Line 95:
*Patients with neuroma usually appear with antalgic posture.<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*Patients with neuroma usually appear with antalgic posture.<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*Physical examination may be remarkable for:
*Physical examination may be remarkable for:
:*Tenderness to palpation
:*[[Tenderness]] to palpation
:*Limitation of range of motion
:*Limitation of range of motion
:*[[Pain|Dysesthetic pain]]  
:*[[Pain|Dysesthetic pain]]  
Line 103: Line 103:
   
   
===Imaging Findings===
===Imaging Findings===
*On ultrasound, neuroma is characterized by the following findings:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*On MRI, characteristic findings of neuroma include:
:*Round to ovoid
:*Well-defined, hypoechoic lesion
:*Located in the intermetatarsal space proximal to the metatarsal head
*On ultrasound, traumatic neuroma is characterized by the following findings:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
:*Swollen nerve (mass-like)
:*Hypoechoic
:*Loss of normal fibrillar pattern
:*Usually small, but may be as large as 5 cm.
*On MRI, characteristic findings of neuroma, include:
:*Dumbbell/ovoid-shaped lesion at a similar position to that described on ultrasound
:*Dumbbell/ovoid-shaped lesion at a similar position to that described on ultrasound
:*T1: typically low-to-iso signal  
:*T1: typically low-to-iso signal  
:*T2: typically low signal but can sometimes be intermediate in signal
:*T2: typically low signal but can sometimes be intermediate in signal
:*T1 C+ (Gd): tends to show intense enhancement
:*T1 C+ (Gd): tends to show intense enhancement
*On MRI, characteristic findings of traumatic neuroma, include:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*On MRI, characteristic findings of traumatic neuroma include:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
:*Fusiform swelling of a nerve or a bulbous mass at a nerve end
:*Fusiform swelling of a nerve or a bulbous mass at a nerve end
:*The parent nerve of some small nerve may difficult or impossible to discern
:*The parent nerve of some small nerve may difficult or impossible to discern
Line 126: Line 117:
Image:Morton-neuroma-2.png| Morton neuroma MRI<SMALL>Courtesy of Radiopedia</SMALL>
Image:Morton-neuroma-2.png| Morton neuroma MRI<SMALL>Courtesy of Radiopedia</SMALL>
</gallery>  
</gallery>  
*On ultrasound, neuroma is characterized by the following findings:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
:*Round to ovoid
:*Well-defined, hypoechoic lesion
:*Located in the intermetatarsal space proximal to the metatarsal head
*On ultrasound, traumatic neuroma is characterized by the following findings:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
:*Swollen nerve (mass-like)
:*Hypoechoic
:*Loss of normal fibrillar pattern
:*Usually small, but may be as large as 5 cm.


== Treatment ==
== Treatment ==
=== Medical Therapy ===
=== Medical Therapy ===
*Medical therapy for neuroma, include:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*Medical therapy for neuroma may include:<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
:*[[Tricyclic antidepressant|Tricyclic antidepressants]]  
:*[[Tricyclic antidepressant|Tricyclic antidepressants]]  
:*Anticonvulsants (more effective)  
:*Anticonvulsants (more effective)  
Line 137: Line 138:
=== Surgery ===
=== Surgery ===
*Surgery is the mainstay of therapy for neuroma.
*Surgery is the mainstay of therapy for neuroma.
*Surgical excision is the treatment of choice for patients with neuroma with a relatively good success rate, around 80%.
*Surgical excision is the treatment of choice for patients with neuroma; this surgical intervention is associated with a relatively favorable success rate, approximately 80%.
*The recurrence rate after surgery is as high as 50%
*The recurrence rate after surgery is as high as 50%.


=== Prevention ===
=== Prevention ===
*There are no primary preventive measures available for neuroma.<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*There are no primary preventive measures available for neuroma.<ref name="morton">Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016</ref>
*Secondary prevention measures, include: personal hygiene measures, such as wearing ergonomic shoes.
*Secondary prevention measures include: personal hygiene measures, such as wearing ergonomic shoes.


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
   
   
[[Category: Oncology]]
[[Category:Oncology]]
[[Category:FinalQCRequired]]

Revision as of 13:42, 2 August 2016

WikiDoc Resources for Neuroma

Articles

Most recent articles on Neuroma

Most cited articles on Neuroma

Review articles on Neuroma

Articles on Neuroma in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Neuroma

Images of Neuroma

Photos of Neuroma

Podcasts & MP3s on Neuroma

Videos on Neuroma

Evidence Based Medicine

Cochrane Collaboration on Neuroma

Bandolier on Neuroma

TRIP on Neuroma

Clinical Trials

Ongoing Trials on Neuroma at Clinical Trials.gov

Trial results on Neuroma

Clinical Trials on Neuroma at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Neuroma

NICE Guidance on Neuroma

NHS PRODIGY Guidance

FDA on Neuroma

CDC on Neuroma

Books

Books on Neuroma

News

Neuroma in the news

Be alerted to news on Neuroma

News trends on Neuroma

Commentary

Blogs on Neuroma

Definitions

Definitions of Neuroma

Patient Resources / Community

Patient resources on Neuroma

Discussion groups on Neuroma

Patient Handouts on Neuroma

Directions to Hospitals Treating Neuroma

Risk calculators and risk factors for Neuroma

Healthcare Provider Resources

Symptoms of Neuroma

Causes & Risk Factors for Neuroma

Diagnostic studies for Neuroma

Treatment of Neuroma

Continuing Medical Education (CME)

CME Programs on Neuroma

International

Neuroma en Espanol

Neuroma en Francais

Business

Neuroma in the Marketplace

Patents on Neuroma

Experimental / Informatics

List of terms related to Neuroma

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Synonyms and keywords: Traumatic neuroma; Morton neuroma; Joplin neuroma

Overview

Neuroma (Neuro- is from the Greek for nerve) is defined as a benign tumor of a nerve. However, neuroma commonly refers to any tumor of cells of the nervous system.[1] Neuromas form part of the peripheral nerve sheath tumors. Neuroma was first described by Thomas Morton in 1876. Neuromas may be classified according to histopathological features into 3 groups: Morton's neuroma, traumatic neuroma, and neoplasic neuromas. The pathogenesis of neuroma is characterized by neural degeneration with epineural and endoneural vascular hyalinization, and perineural fibrosis. Neuroma is more commonly observed among patients aged between 15 to 50 years old. Neuroma is more commonly observed among middle aged adults. Females are more commonly affected with neuroma than males. The female to male ratio is approximately 5:1. Common risk factors in the development of neuroma include improper footwear and high impact sports (e.g., rock-climbing, ballet dancing). A major complication of neuroma is chronic neuropathic pain. On ultrasound, neuroma is characterized as a well-defined, hypoechoic lesion located in the intermetatarsal space proximal to the metatarsal head. Patients with neuroma usually appear with antalgic posture. Physical examination may be remarkable for tenderness to palpation and dysesthetic pain. Surgical excision is the treatment of choice for patients with neuroma; this surgical intervention is associated with a relatively favorable success rate, approximately 80%. The recurrence rate after surgery is as high as 50%.

Historical Perspective

Neuroma was first described by Thomas Morton in 1876.

Classification

  • Neuroma may be classified according to histopathological features into 3 groups:[2]
  • Morton neuroma
  • Symptomatic perineural fibrosis around a plantar digital nerve of the foot
  • Also known as Morton’s metatarsalgia
  • Traumatic neuroma
  • Arises from nerve injury (often as a result of surgery)
  • They occur at the end of injured nerve fibers as a form of unregulated nerve regeneration
  • Subtype of traumatic neuroma, called "Joplin neuroma" (a compression traumatic neuroma)
  • Occurs most commonly near a scar
  • Often very painful
  • Neoplasic neuroma
  • Solid nodular mass
  • Usually, separate from nerve fibers

Pathophysiology

  • The pathogenesis of neuroma is characterized by neural degeneration with epineural and endoneural vascular hyalinization, and perineural fibrosis.[2]
  • The pathogenesis of traumatic neuroma is characterized by a chronic reactive fibroinflammatory disorganized regeneration around a nerve after an injury (such as traction injury or chronic repetitive stress).
  • Morton neuroma is characterized by being located in the 3rd web-space, between 3rd and 4th metatarsal heads.
  • Another subtype of traumatic neuroma is terminal neuroma (also known as "stump neuroma") which can occur after transection of the nerve (e.g. limb amputation).
  • The are no genetic mutations associated with the development of neuroma.
  • On gross pathology, characteristic findings of neuroma, include:[3][4]
  • Adherent fibrofatty tissue
  • Yellowish small mass
  • On microscopic histopathological analysis, characteristic findings of neuroma, include:[3][4]
  • Extensive fibrosis around and within the nerve
  • Digital artery
  • Thrombosis
  • Arterial thickening
  • The image below demonstrates microscopic histopathological analysis of traumatic neuroma:

Causes

  • Common causes of neuroma include:[3][4]
  • Indirect nerve trauma
  • Traction injury
  • Chronic repetitive stress

Differentiating Neuroma from other Diseases

  • Neuroma must be differentiated from other diseases that cause forefoot pain and numbness such as:[2][4]

Epidemiology and Demographics

  • Neuroma is a uncommon disease.[4]

Age

  • Neuroma is more commonly observed among patients aged between 15 to 50 years old.[4]
  • Neuroma is more commonly observed among middle aged adults.

Gender

  • Females are more commonly affected with neuroma than males.
  • The female to male ratio is approximately 5:1.[4]

Race

  • There is no racial predilection for neuroma.

Risk Factors

  • Common risk factors in the development of neuroma include:[3]
  • Improper footwear
  • High-impact sports (e.g., rock-climbing, ballet dancing)

Natural History, Complications and Prognosis

  • The majority of patients with neuroma are symptomatic at the time of diagnosis.[2]
  • Early clinical features include neuropathic pain or local tenderness.
  • If left untreated, the majority of patients with neuroma may progress to develop difficulty walking and limping.
  • A significant complication of neuroma is chronic neuropathic pain.
  • Prognosis is generally good, and the survival rate of patients with neuroma is 99%.

Diagnosis

Symptoms

  • Neuroma is usually asymptomatic.
  • Symptoms of neuroma may include:[2]
  • Focal area of neuropathic pain
  • No alleviating factors
  • Aggravating with movement

Physical Examination

  • Patients with neuroma usually appear with antalgic posture.[2]
  • Physical examination may be remarkable for:

Laboratory Findings

  • There are no specific laboratory findings associated with neuroma.[3]

Imaging Findings

  • On MRI, characteristic findings of neuroma include:
  • Dumbbell/ovoid-shaped lesion at a similar position to that described on ultrasound
  • T1: typically low-to-iso signal
  • T2: typically low signal but can sometimes be intermediate in signal
  • T1 C+ (Gd): tends to show intense enhancement
  • On MRI, characteristic findings of traumatic neuroma include:[2]
  • Fusiform swelling of a nerve or a bulbous mass at a nerve end
  • The parent nerve of some small nerve may difficult or impossible to discern
  • T2/STIR:inhomogeneous hyperintensity (may have a hypointense rim)
  • T1 C+ (Gd): variable contrast enhancement
  • The image below demonstrates MRI findings of traumatic neuroma.
  • On ultrasound, neuroma is characterized by the following findings:[2]
  • Round to ovoid
  • Well-defined, hypoechoic lesion
  • Located in the intermetatarsal space proximal to the metatarsal head
  • On ultrasound, traumatic neuroma is characterized by the following findings:[2]
  • Swollen nerve (mass-like)
  • Hypoechoic
  • Loss of normal fibrillar pattern
  • Usually small, but may be as large as 5 cm.

Treatment

Medical Therapy

  • Medical therapy for neuroma may include:[2]

Surgery

  • Surgery is the mainstay of therapy for neuroma.
  • Surgical excision is the treatment of choice for patients with neuroma; this surgical intervention is associated with a relatively favorable success rate, approximately 80%.
  • The recurrence rate after surgery is as high as 50%.

Prevention

  • There are no primary preventive measures available for neuroma.[2]
  • Secondary prevention measures include: personal hygiene measures, such as wearing ergonomic shoes.

References

  1. "Neuroma". Dorland's Illustrated Medical Dictionary (32nd ed.). Oxford University Press. 2011. p. 5287. ISBN 978-1-4557-0985-4. Retrieved 25 August 2013.
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 Neuroma. Radiopedia http://radiopaedia.org/cases/morton-neuroma-2 Accessed on April 21, 2016
  3. 3.0 3.1 3.2 3.3 3.4 Neuroma. Wikipedia. https://en.wikipedia.org/wiki/Neuroma Accessed on April 21, 2016
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 Wu J, Chiu DT (1999). "Painful neuromas: a review of treatment modalities". Ann Plast Surg. 43 (6): 661–7. PMID 10597831.