Painful Neuromas

OBJECTIVES: To perform a topical review of the published literature on painful neuromas. METHODS: A MEDLINE search was performed using the MESH terms "neuroma", "pain", "diagnosis", and "treatment" for all dates. RESULTS: Acoustic neuromas and intraabdominal neuromas were excluded from a total of 7616 articles. The reference lists from these articles were further reviewed to obtain other relevant articles. DISCUSSION: Neuromas develop as part of a normal reparative process following peripheral nerve injury. Painful neuromas can induce intense pain resulting in immense suffering and disability. MRI aids the diagnosis, but, ultrasound imaging allows cost effective accurate diagnosis and localization of neuromas by demonstrating their direct contiguity with the nerve of origin. Management options for painful neuromas include pharmacotherapy, prosthetic adjustments, steroid injection, chemical neurolysis, cryoablation, and radiofrequency ablation. Ultrasound imaging guidance has improved the success in localizing and targeting the neuromas. This review discusses the patho-physiology and accumulated evidence for various therapies and the current percutaneous interventional management options for painful neuromas.