Traumatic neuroma

Last revised by Maulik S Patel on 26 Jan 2022

Traumatic neuromas may occur from acute or chronic injury to a nerve.

The patient presents with a focal area of pain and tenderness to palpation. There should be a history of injury (including iatrogenic injury, i.e. surgery) to the area. They may develop 1-12 months after nerve injury.

A traumatic neuroma is not a neoplasm, but is formed from one of two main processes:

  • spindle neuroma: from a reactive fibroinflammatory disorganized regeneration around a nerve after an injury, such as traction injury or chronic repetitive stress (e.g. Morton neuroma)
  • terminal neuroma (such as "stump neuroma"): can occur after transection of the nerve (e.g. limb amputation, ilioinguinal pain post herniorrhaphy)
  • at the site of the patient's pain
    • swollen nerve, occasionally mass-like (comparison with the opposite side is often helpful)
    • hypoechoic
    • loss of normal fibrillar pattern
    • usually small, but can be as large as 5 cm
  • the parent nerve of some small nerve may be difficult or impossible to discern
  • fusiform swelling of a nerve or a bulbous mass at a nerve ending
    • the parent nerve of some small nerves may be difficult or impossible to discern
  • T2/STIR
    • inhomogeneous hyperintensity
    • may have a hypointense rim
  • T1 C+ (Gd): variable contrast enhancement

Treatment varies according to local expertise but can range from excision, anesthetic injection, or alcohol ablation.

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