A neuroma in the hand is a condition involving nerve tissue. It arises when a nerve experiences irritation or damage, leading to changes in its structure. This localized nerve thickening can occur in various parts of the hand, affecting its normal function and sensation.
Understanding Hand Neuromas
A neuroma is a benign thickening of nerve tissue, often forming after a nerve has been cut, crushed, or injured. It is not a cancerous growth but a reactive process of disorganized nerve regeneration. This can occur anywhere a nerve is damaged or subjected to chronic irritation.
In the hand, neuromas frequently develop following trauma, such as lacerations, crush injuries, or surgical procedures that involve nerve transection. These are called “traumatic neuromas” or “stump neuromas,” especially when they form at the end of a severed nerve. Less commonly, a neuroma might arise from chronic compression, similar to a Morton’s neuroma in the foot.
Recognizing Neuroma Symptoms
Individuals with a hand neuroma report uncomfortable sensations related to the affected nerve. Pain is a common symptom, often described as sharp, burning, or shooting, sometimes feeling like an electric shock. This discomfort can be localized to the neuroma or radiate along the nerve’s distribution.
Other symptoms include numbness, tingling, or a “pins-and-needles” sensation in the area supplied by the irritated nerve. These symptoms are often provoked or worsened by direct touch or pressure on the neuroma, or by movements of the hand or wrist that stretch or compress the nerve. Symptoms can range from intermittent mild irritation to constant, debilitating discomfort.
Visualizing Hand Neuromas
Unlike other hand conditions, a neuroma is not visible externally as a lump on the skin surface. The thickening occurs within the deeper tissues around the nerve. In some instances, a small, firm, and tender lump might be palpable under the skin, especially if the neuroma is superficial.
When medical professionals refer to “pictures” of hand neuromas, they are referring to diagnostic imaging rather than external photographs. An ultrasound examination can reveal a thickened or swollen nerve, appearing as a hypoechoic mass along the nerve’s path. Magnetic resonance imaging (MRI) can also visualize the neuroma, showing a focal area of nerve scarring or disorganization. During surgical procedures, the neuroma can be observed as a bulbous or irregular enlargement of the nerve tissue.
Diagnosis and Treatment Approaches
Diagnosing a hand neuroma begins with a physical examination. A doctor assesses the hand for tenderness and attempts to reproduce symptoms. A specific test called Tinel’s sign involves gently tapping along the course of the nerve; if this elicits a tingling, electric shock-like sensation, it suggests nerve irritation or a neuroma. Palpation of the affected area may also reveal a tender nodule.
Imaging studies are used to confirm the diagnosis and rule out other conditions. Ultrasound is the initial imaging choice due to its ability to visualize soft tissues and nerve structures, showing nerve thickening or disruption. MRI can provide more detailed anatomical information, particularly useful for larger or deeper neuromas.
Treatment for hand neuromas starts with conservative measures to manage symptoms. These include rest, splinting to immobilize the area, and oral anti-inflammatory medications to reduce nerve irritation. Physical therapy may be recommended to improve hand function and reduce sensitivity.
Corticosteroid injections directly into the neuroma can provide temporary relief by reducing inflammation around the nerve. If conservative approaches do not provide sufficient relief, surgical options may be considered. Surgical interventions can range from neurolysis, which involves freeing the nerve from surrounding scar tissue, to neurectomy, the surgical removal of the neuroma, sometimes followed by nerve repair or grafting to restore continuity.