Neuroma
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Synonyms and keywords: Traumatic neuroma; Morton neuroma; Joplin neuroma
Overview
Neuroma (Neuro- is from the Greek for nerve) is defined as a tumor of a nerve. However, neuroma commonly refers to any tumor of cells of the nervous system and forms a part of peripheral nerve sheath tumors.
Historical Perspective
- Neuroma was first described by Thomas Morton in 1876
Classification
- Neuroma may be classified according to histopathological features into 3 groups:
- Morton neuroma
- Symptomatic perineural fibrosis around a plantar digital nerve of the foot
- Also known as Morton’s metatarsalgia.
- Traumatic neuroma
- Arises from nerve injury (often as a result of surgery).
- They occur at the end of injured nerve fibres as a form of uneffective, unregulated nerve regeneration
- Subtype of traumatic neuroma, called "Joplin neuroma" (a compression traumatic neuroma)
- Occurs most commonly near a scar
- Often very painful
- Neoplasic neuroma
- Solid nodular mass
- Are separate from nerve fibers
Pathophysiology
- The pathogenesis of neuroma is characterized by
- The has been associated with the development of neuroma.
- On gross pathology, characteristic findings of neuroma, include:
- Adherent fibrofatty tissue
- Yellowish small mass
- On microscopic histopathological analysis, characteristic findings of neuroma, include:
- Extensive fibrosis around and within the nerve
- Digital artery
- Thrombosis
- Arterial thickening
Causes
- Common causes of neuroma, include:
- Indirect nerve trauma
Differentiating Neuroma from other Diseases
- Neuroma must be differentiated from other diseases that cause forefoot pain, and numbness, such as:
- Stress fracture (neck of the metatarsal)
- Rheumatoid arthritis
- Hammertoe
Epidemiology and Demographics
- The prevalence of neuroma is approximately [number or range] per 100,000 individuals worldwide.
- In [year], the incidence of neuroma was estimated to be [number or range] cases per 100,000 individuals in [location].
Age
- Patients of all age groups may develop neuroma .
- Neuroma is more commonly observed among patients aged [age range] years old.
- Neuroma is more commonly observed among [elderly patients/young patients/children].
Gender
- Neuroma affects men and women equally.
- [Gender 1] are more commonly affected with neuroma than [gender 2].
- The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
Race
- There is no racial predilection for neuroma .
- Neuroma usually affects individuals of the [race 1] race.
- [Race 2] individuals are less likely to develop neuroma .
Risk Factors
- Common risk factors in the development of neuroma are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
Natural History, Complications and Prognosis
- The majority of patients with neuroma remain asymptomatic for [duration/years].
- Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
- If left untreated, [#%] of patients with neuroma may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
- Common complications of neuroma include [complication 1], [complication 2], and [complication 3].
- Prognosis is generally [excellent/good/poor], and the [1/5/10year mortality/survival rate] of patients with neuroma is approximately [#%].
Diagnosis
Diagnostic Criteria
- The diagnosis of neuroma is made when at least [number] of the following [number] diagnostic criteria are met:
- [criterion 1]
- [criterion 2]
- [criterion 3]
- [criterion 4]
Symptoms
- Neuroma is usually asymptomatic.
- Symptoms of neuroma may include the following:
- [symptom 1]
- [symptom 2]
- [symptom 3]
- [symptom 4]
- [symptom 5]
- [symptom 6]
Physical Examination
- Patients with neuroma usually appear [general appearance].
- Physical examination may be remarkable for:
- [finding 1]
- [finding 2]
- [finding 3]
- [finding 4]
- [finding 5]
- [finding 6]
Laboratory Findings
- There are no specific laboratory findings associated with neuroma .
- A [positive/negative] [test name] is diagnostic of neuroma .
- An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of neuroma .
- Other laboratory findings consistent with the diagnosis of neuroma include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
Imaging Findings
- There are no [imaging study] findings associated with neuroma .
- [Imaging study 1] is the imaging modality of choice for neuroma .
- On [imaging study 1], neuroma is characterized by [finding 1], [finding 2], and [finding 3].
- [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].
Other Diagnostic Studies
- Neuroma may also be diagnosed using [diagnostic study name].
- Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
Treatment
Medical Therapy
- There is no treatment for neuroma ; the mainstay of therapy is supportive care.
- The mainstay of therapy for neuroma is [medical therapy 1] and [medical therapy 2].
- [Medical therapy 1] acts by [mechanism of action1].
- Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
Surgery
- Surgery is the mainstay of therapy for neuroma .
- [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of neuroma .
- [Surgical procedure] can only be performed for patients with [disease stage] neuroma .
Prevention
- There are no primary preventive measures available for neuroma .
- Effective measures for the primary prevention of neuroma include [measure1], [measure2], and [measure3].
- Once diagnosed and successfully treated, patients with neuroma are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].