Dorsoradial wrist neuromas diagnosed and treated by traditional techniques remain the most difficult for which to achieve satisfactory pain relief. Between 1981 and 1985, 52 patients with dorsoradial wrist neuromas were treated by neuroma resection and implantation of the nerves innervating the neuroma into the brachioradialis muscle. Critical to, this treatment schema was preoperative use of nerve blocks to diagnose overlapping patterns of the cutaneous nerves in this region. Of patients for whom this technique was the first surgical treatment of their neuroma (primary group), 100% achieved good to excellent pain relief. Among patients in whom the neuroma had been operated on once previously (first recurrence group), 88% achieved good to excellent pain relief with the technique described in this article. Of patients treated who had had 3 or more previous “neuroma” operations (multiple recurrence group), this technique resulted in excellent pain relief in 56%. Factors contributing to a poorer result in the multiple recurrence group included duration of pain longer than 24 months and the patient's unemployment.
The diagnostic and surgical approach detailed in this article has yielded clinical results that recommend this approach not only as the primary treatment of choice but also as the treatment to help patients with pain from recurrent dorsoradial neuromas. The apparent susceptibility of the superficial branch of the radial nerve (SBRN) to form painful neuromas has been well documented. Once established, the neuroma appears particularly resistant to treatment. Based on experimental and cadaveric studies, we have formulated a treatment plan for patients with dorsoradial wrist neuromas. It involves careful preoperative identification of any overlapping cutaneous nerves innervating the neuroma and intraoperative excision of the neuroma with proximal implantation of the sensory nerves into the brachioradialis (BR) muscle. This article reports our experience with this treatment in 52 patients with dorsoradial wrist neuromas.
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