title: Ultrasound demonstration of vascularity changes with changes in pain perception in a stump neuroma.
abstract: BACKGROUND
  Pain in the residual limb after an amputation has posed many challenges in treatment. Ultrasound (US) imaging has helped in the visualization of neuroma and its selective targeting for interventions.
  
  
  OBJECTIVE
  A 58-year-old man presented to the pain clinic with chronic stump pain after a below knee amputation during the Vietnam war. After multiple similar steroid injections around the area of pain in the following months, we decided to use the US to better target the stump neuroma. Color flow Doppler showed extensive vascularity around the posterior aspect of the neuroma where there was scar tissue. During a follow-up visit for intra-articular steroid injection to the L5-S1 left lumbar facet for coincidental lumbar facet arthropathy, an US scan of the stump neuroma with color flow Doppler was performed out of curiosity. Multiple US views of the neuroma with color flow Doppler was performed and all showed a significant decrease in vascularity. Similar absence of vascularity was noted after a spinal cord stimulator placement.
  
  
  CONCLUSIONS
  This is a case report of US demonstration of increased vascularity in a stump neuroma coinciding with the patient's pain. This serendipitous demonstration makes the need for US visualization useful in the evaluation of neuroma. It is also useful to use US guidance to avoid the vascular structures when testing the beneficial response to various medications. Larger randomized controlled studies are needed to further correlate the US demonstration of vascularity and neuroma pain.
authors.affiliation: Clement Zablocki VA Medical Center, Milwaukee, WI 53295, USA. hshankar@mcw.edu
authors.forename: Hariharan
authors.initials: H
authors.lastname: Shankar