Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with localized neuropathic pain, dysesthesia, and focal tenderness along the course of a previously injured peripheral nerve. Symptoms are exacerbated by direct palpation (Tinelโs sign positive) and mechanical irritation. History is significant for prior trauma/surgical intervention at the site, with persistent sensory deficits distal to the lesion.
Clinical Examination Findings
Physical examination reveals a palpable, firm, fusiform mass along the nerve axis. Tinelโs sign is positive at the site of the neuroma with distal radiation of paresthesia. Sensory mapping demonstrates focal hyperesthesia at the site and distal hypoesthesia/anesthesia in the nerve distribution. Motor function assessment shows no evidence of complete denervation, consistent with a neuroma-in-continuity.
Treatment Protocol
Initial management includes conservative therapy with desensitization, topical lidocaine/capsaicin, and neuropathic pain medications (gabapentinoids). If refractory to conservative measures, surgical intervention is indicated, including neurolysis, resection with nerve grafting, or nerve transfer, depending on the severity of functional impairment and nerve integrity.