Introduction to Neuromas in Amputated Upper Limbs

Trauma can cause damage to a nerve resulting in swelling of the nerve or a jumbled overgrowth of nerve cells which is called a neuroma. Neuromas are common following an amputation of an upper limb. When a nerve is cut, the nerve fibers try to grow to reconnect with the other side of the nerve. Since there is no longer the chance for reconnection, the nerve fibers tend to ball up into a painful lump at the end of the cut nerve. A neuroma often causes localized sharp, burning pain when the skin over the neuroma is touched or any pressure is applied. A neuroma can also be the genesis of shooting pain, numbness and tingling or may contribute to phantom pain. 

If you are experiencing pain in your residual limb, it may be difficult to determine what type of pain it is and what is causing the pain. For that reason, it’s important to talk to your doctor, your prosthetist and your clinical therapy specialist about what you are experiencing. The fit of your prosthetic device will be assessed to see if the socket is contributing to your discomfort and can be modified to reduce the pain. The possibility of phantom pain will be addressed, and treatment options provided. If a neuroma is suspected, your medical professionals will need to have a solid knowledge of neural pathways such that they can tap on your skin in certain areas to determine if it is a disorganized end of a cut nerve that is causing the issue.

Treatment for a neuroma may include medication and steroid injections. If that does not work, sometimes, a surgery is prescribed. However, some of the traditional surgeries that have been utilized in an attempt to alleviate neuroma pain have not been effective and the neuroma has grown back. Fortunately, there are some relatively new surgeries that are showing great promise for the relief of neuroma pain in amputees. Those surgeries are Targeted Muscle Reinnervation (TMR) and Regenerative Peripheral Nerve Interfaces (RPNI). There are other promising treatments which are being studied, such as non-invasive focused ultrasound, that may be helpful in treating neuromas. 

Our patient Kate benefitted from TMR surgery.

At our Arm Dynamics centers, we utilize an in-house tool, The Comprehensive Arm Prosthesis and Rehabilitation Outcomes Questionnaire (CAPROQ) to assess pain and numbness to help determine what issues you are facing. If pain is an issue, we help to diagnose the type of pain and potential cause of the pain. Any prosthetic fit issues are addressed and techniques such as desensitization methods, select exercises, various modalities (heat, ice, electrical stimulation, etc.) and massage are provided, if appropriate. If it appears that you may benefit from medications, steroid injections, surgery, or other treatment not available at our centers, we will help you connect with a knowledgeable medical professional who can assist you with those treatments.

If you would like more information about how we can help you assess and manage any pain that you experience in your residual limb, please contact us. If you would like to share how you have weathered your own neuroma pain, please do so in the comment section below.

You can find more related resources below:

• Introduction to Phantom Limb Pain and Phantom Sensations
• Introduction to Residual Limb Pain
• Introduction to Targeted Muscle Reinnervation (TMR)
• Daily Care of Your Residual Limb
• How Outcome Measures Can Maximize a Patient’s Rehabilitation Potential