A neuroma in the hand is a non-cancerous growth or thickening of peripheral nerve tissue. It often develops after a nerve injury or irritation, forming a disorganized mass of nerve cells at the site of damage. This condition is a recognized consequence of nerve disruption or trauma in the upper extremity.
How Neuromas Form in the Hand
Neuromas in the hand typically arise from the body’s attempt to repair a damaged nerve. When a nerve is cut, crushed, or subjected to excessive stretching, the nerve fibers try to regenerate. However, if the regenerating axons are unable to reconnect properly with their intended targets, they can form a tangled mass instead of re-establishing a functional connection.
This disorganized growth of nerve cells and scar tissue can also develop from blunt trauma or nerve retraction, even if the nerve is not fully severed. Common scenarios leading to hand neuromas include lacerations, fractures, crush injuries, or surgical incisions where nerves may be inadvertently damaged. Repetitive strain or continuous pressure on the hand’s nerves can also contribute to their irritation and subsequent neuroma formation.
Specific nerves in the hand, such as the superficial radial nerve, may be more prone to neuroma development. These growths tend to be small and firm in texture, representing the body’s often unsuccessful attempt at nerve regeneration.
Identifying Symptoms
Individuals with a neuroma in the hand can experience a variety of sensations, which often stem from the thickened nerve tissue. Pain is a common symptom, frequently described as burning, sharp, or shooting. This discomfort can also manifest as tingling, numbness, or electric shock-like sensations in the affected area.
The symptoms may be intermittent or constant and often worsen with activity or pressure applied to the neuroma. For instance, gripping or repetitive finger movements can intensify the pain, making everyday tasks challenging. The location of these symptoms typically corresponds to the specific nerve affected by the neuroma, localizing pain and abnormal sensations to particular fingers or parts of the hand. Some individuals may also experience hypersensitivity to touch in the affected finger, or a loss of sensation, which can hinder fine motor skills.
Diagnosis and Treatment Options
Diagnosing a neuroma in the hand usually begins with a physical examination and a review of the patient’s medical history. A healthcare provider will assess pain and sensitivity, identifying tender areas by tapping on peripheral nerve pathways, which can elicit characteristic painful or tingling sensations. A temporary injection of local anesthetic near the suspected neuroma can also help confirm the diagnosis, as significant pain reduction after the injection suggests a neuroma.
Imaging tests like ultrasound or MRI may be used to visualize the nerve tissue, determine the neuroma’s size, or rule out other conditions. Nerve conduction studies can also assess residual nerve function after an injury.
Treatment options for hand neuromas range from non-surgical approaches to surgical interventions, depending on symptom severity and the neuroma’s characteristics.
Non-Surgical Treatments
Non-surgical treatments aim to manage symptoms without operative intervention. These may include:
Rest
Activity modification
Splinting to reduce pressure on the affected nerve
Anti-inflammatory medications
Physical therapy involving massage and exercises
Corticosteroid injections
Oral analgesia, antidepressants, or anticonvulsant medications to help manage neuropathic pain
Surgical Interventions
If non-surgical methods do not provide adequate relief after about six months, surgical intervention becomes a consideration. Surgical options include neurectomy, which involves the removal of the neuroma, sometimes followed by nerve repair or reconstruction. In some cases, the severed nerve end may be transposed or buried into adjacent muscle, bone, or vein to reduce direct stimulation and prevent recurrence. Nerve grafting may also be employed to bridge a gap after neuroma excision, aiming to alleviate pain and restore function.