Neuroma
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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 and forms a part of peripheral nerve sheath tumors.
Historical Perspective
- Neuroma was first described by Thomas Morton in 1876
Classification
- Neuroma may be classified according to histopathological features into 3 groups:
- 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 fibres as a form of uneffective, 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 characterised by neural degeneration with epineural and endoneural vascular hyalinization, and perineural fibrosis.
- Morton neuroma is characterized by being located in the 3rd web-space, between 3rd and 4th metatarsal heads.
- The are no genetic mutations associated with the development of neuroma.
- On gross pathology, characteristic findings of neuroma, include:
- Adherent fibrofatty tissue
- Yellowish small mass
- On microscopic histopathological analysis, characteristic findings of neuroma, include:
- Extensive fibrosis around and within the nerve
- Digital artery
- Thrombosis
- Arterial thickening
Causes
- Common causes of neuroma, include:
- Indirect nerve trauma
Differentiating Neuroma from other Diseases
- Neuroma must be differentiated from other diseases that cause forefoot pain, and numbness, such as:
- Stress fracture (neck of the metatarsal)
- Rheumatoid arthritis
- Plexiform neurofibroma
- Hammertoe
Epidemiology and Demographics
- Neuroma is a uncommon disease.
Age
- Neuroma is more commonly observed among patients aged between 15 to 50 years old.
- 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.
Race
- There is no racial predilection for neuroma .
Risk Factors
- Common risk factors in the development of neuroma, include:
Natural History, Complications and Prognosis
- The majority of patients with neuroma remain asymptomatic for [duration/years].
- Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
- If left untreated, [#%] of patients with neuroma may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
- Common complications of neuroma include [complication 1], [complication 2], and [complication 3].
- Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with neuroma is approximately [#%].
Diagnosis
Symptoms
- Neuroma is usually asymptomatic.
- Symptoms of neuroma may include the following:
- [symptom 1]
- [symptom 2]
- [symptom 3]
- [symptom 4]
- [symptom 5]
- [symptom 6]
Physical Examination
- Patients with neuroma usually appear [general appearance].
- Physical examination may be remarkable for:
- [finding 1]
- [finding 2]
- [finding 3]
- [finding 4]
- [finding 5]
- [finding 6]
Laboratory Findings
- There are no specific laboratory findings associated with neuroma.
Imaging Findings
- On ultrasound, neuroma is characterized by the following findings:
- Round to ovoid
- Well-defined, hypoechoic lesion
- Located in the intermetatarsal space proximal to the metatarsal head
- On MRI, characteristic findings of neuroma, include:
Other Diagnostic Studies
- Neuroma may also be diagnosed using [diagnostic study name].
- Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
Treatment
Medical Therapy
- There is no treatment for neuroma ; the mainstay of therapy is supportive care.
- The mainstay of therapy for neuroma is [medical therapy 1] and [medical therapy 2].
- [Medical therapy 1] acts by [mechanism of action1].
- Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
Surgery
- Surgery is the mainstay of therapy for neuroma .
- [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of neuroma .
- [Surgical procedure] can only be performed for patients with [disease stage] neuroma .
Prevention
- There are no primary preventive measures available for neuroma .
- Effective measures for the primary prevention of neuroma include [measure1], [measure2], and [measure3].
- Once diagnosed and successfully treated, patients with neuroma are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].