title: Outcomes of the surgical treatment of peripheral neuromas of the hand and forearm: a 25-year comparative outcome study.
abstract: OBJECTIVE
  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.
authors.affiliation: From the *Division of Plastic Surgery, University of Cincinnati, Cincinnati, OH; and †Mayo Clinic, Rochester, MN.
authors.forename: Darlene Michele
authors.initials: DM
authors.lastname: Guse
authors.forename: Steven Lawrence
authors.initials: SL
authors.lastname: Moran
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000294:innervation / Q000601:surgery*; D006225:Hand / Q000294:innervation / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000517:prevention & control; D016067:Nerve Transfer; D009463:Neuroma / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult