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Treatment of Symptomatic Neuromas of the Dorsal Radial Sensory Nerve using a Nerve Conduit
Joshua M. Abzug, MD1; A. Lee Osterman, MD2; John S. Taras, MD3; Sergio Rodriguez, MD4
1Department of Orthopaedic Surgery, University of Maryland, Baltimore, MD; 2The Philadelphia Hand Center, Thomas Jefferson University, Philadelphia, PA; 3The Philadelphia Hand Center, PC, Philadelphia, PA; 4McAllen Hand Center, Edinburg, TX

Introduction: Established symptomatic neuromas of the dorsal radial sensory nerve (DRSN) are difficult problems for which no ideal treatment exists. This paper studied the role of neurolysis and wrapping of the neuroma in a resorbable collagen conduit.

Methods: Twenty one patients with an average age of 33 years (20-52) met the entry criteria:  intractable DRSN pain; failure of time, desensitization, and neuroleptic medication; positive electrical studies or a surgically documented DRSN injury. All had DRSN neurolysis and wrapping of the neuroma segment with a resorbable collagen conduit (NeuraWrap®).   Results were evaluated clinically, by VAS, and by DASH questionnaire.

Results: Eleven patients had previous surgery to the radial side of the wrist and 10 had closed injuries related to crush injury, percutaneous needles, radial fracture, or casting. The median time from original injury to surgery was 8 months (4-37).   Mean follow-up was 2.8 years (1.2-4.5) with no patient lost to follow-up. In 19/ 21 hypersensitivity was improved and watchbands, bracelets and sleeves were now tolerated. Subjectively preoperative numbness decreased in 66%.  Preoperative Tinels decreased from 100% to 38%. VAS (0-10) improved both at rest and in activity: (rest 5 to 0.7; activity 7 to 1.8). Dash improved 71(+/-22) to 29(+/- 18).  Grip strength improved from 61% to 92%. Key and Tip pinch showed similar data: 55% to 84% and 62% to 88%, respectively. Eight patients not working preoperatively were able to return to work, and all patients working preoperatively continued to work postoperatively.  Four high level athletes were able to return to their sport.

Discussion and Conclusion: Neurolysis and wrapping with a resorbable collagen tube is effective in significantly improving the symptomatic neuroma of the DRSN.

The procedure is not technically difficult, avoids ablation of the nerve and the harvesting of other tissues.

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