Long-term outcomes of symptomatic neuromas in the wrist, hand, and digits: A prospective cohort study

INTRODUCTION: Symptomatic neuromas of the hand and wrist are challenging to treat. We evaluated outcomes following traditional passive surgical techniques for neuromas in the hand, wrist, and digits by examining revision surgery rates, pain outcomes, and patient satisfaction. METHODS: In this multicenter prospective cohort study conducted in the Netherlands, patients who underwent surgery for symptomatic hand and wrist neuromas were analyzed. The primary outcome was revision surgery rate over long-term follow-up. The secondary outcomes included visual analogue scale (VAS, 0-100) pain scores (at rest during loading), achievement of minimally clinically important difference (MCID), function scores (VAS, 0-100), and patient satisfaction, all within 12-months postoperatively. Outcomes were compared between digital and hand-wrist neuroma locations. RESULTS: In 63 patients (83 neuromas), 27% underwent revision surgery with median time to revision of 1.3 years (IQR: 0.7-4.0 years) (median follow-up: 8.4 (IQR: 6.5-10.9) years). VAS pain at rest improved from 48 (95% confidence interval (CI): 42-55) to 25 (15-35) at 12 months (p<0.001), with 61% achieving mild pain and 44% reaching MCID. VAS pain during loading decreased from 66 (60-72) to 45 (34-55) (p<0.001), with 33% achieving mild pain and 28% reaching MCID. Digital neuromas (n=42) showed similar outcomes regarding hand-wrist neuromas (n=41). Overall, patient satisfaction was low (17% at 12 months), though 61% would choose the treatment again. CONCLUSIONS: Traditional surgical techniques for symptomatic neuromas provide modest pain relief and show substantial recurrence (27%). Despite low satisfaction rates, most patients would undergo the treatment again, suggesting incremental benefit. Our results underline the need for alternative active treatment strategies for neuroma management. LEVEL OF EVIDENCE: III - Therapeutic.