Furthermore, localized deactivation of the brain-derived nerve factor (BDNF) has been found to greatly reduce neuropathic pain and influence the regeneration of sensory fibers. Many studies have found that inhibiting nerve growth factor (NGF) following nerve damage lowers neuroma growth and neuropathic pain in rat models ( 14). In this review, we aimed to provide a comprehensive understanding of traumatic peripheral neuroma and its related research progress.

These symptoms could lead to psychological distress and a severe decrease in the quality of life ( 9). Patients may feel burning, stabbing, raw, gnawing, or sickening sensations. Pain, as mentioned before, is among the most common clinical symptoms, including painful hypersensitivity and the presence of a trigger point that causes neuralgic pain. The most common main complaint in patients suffering from peripheral traumatic neuromas remains paresthesia in the innervated area and a painful nodule at the site of injury. It can be concluded that given the mechanism of traumatic neuromas, it is highly related to traumatic limb injury and occurs mostly in orthopedic patients. The former type of trauma could cause fusiform neuromas, which are commonly seen in the digital nerve and median nerve, while the latter form of trauma causes thickening of the fibrous tissue surrounding the nerve, which is involved in cases of Morton neuroma, Bowler's thumb ( 7), and lateral femoral cutaneous neuropathy ( 8). On the other hand, neuroma-in-continuity results from a fusiform swelling of the injured site following the trauma and is further divided into two subtypes: (1) total or partial transection of the nerve (2) repeated blunt trauma to the nerve. Terminal neuromas are generally observed in limb amputation, lower extremities in particular, where the nerve is completely transected without a distal end, rendering it impossible to reestablish innervation by the injured nerve. Depending on the nature of the trauma, traumatic neuromas can be largely categorized into terminal neuroma and neuroma-in-continuity ( 6). In this case, the reinnervation process is deterred when nerve reconstruction is interrupted by the interpolation of scar tissue. Neuromas mostly occur when normal nerve conduction is damaged by injury, inadequate surgical repair, or in some cases, chronic fibro-inflammatory irritation.

From then on, the understanding of traumatic neuromas grew steadily, including the introduction of Morton's neuroma by Morton ( 3), the elucidation of the actual mechanism forming these neuromas by Huber and Lewis ( 4), and the classification system put forward by Swanson ( 5), who also defined neuromas as cutaneous and post-traumatic.Ī neuroma is not a conventional neoplasm that arises from malignant cells, but a local non-neoplastic proliferation of the injured nerve. It was not until 1828 that the term “neuroma” was coined by Wood ( 2), who conducted the first pathological research on such nerve injuries. In 1811, Odier ( 1) discovered that the bulbous stump tissue in the proximal ending of a transected nerve could be extremely sensitive. The history of neuromas dates back to 1634 when Ambroise Pare first described the painful neuroma and treated neuroma with massage and oil. In this review, we aim to start with the possible underlying mechanisms of traumatic neuromas, elaborate on the diagnosis, treatment, and prevention schemes, and discuss the current experiment models and advances in research for the future management of traumatic neuromas. However, researchers and clinicians have yet to reach a consensus regarding traumatic neuromas. While various studies are conducted aiming to improve current diagnosis and management strategies via the induction of emerging imaging tools and surgical or conservative treatment. The most common clinical manifestations include painful hypersensitivity and the presence of a trigger point that causes neuralgic pain, which could seriously decrease the living standards of patients. A traumatic neuroma is not a true malignancy, rather, it is a hyperplastic, reparative nerve reaction after injury and typically manifests as a nodular mass. Traumatic neuromas are infrequent in clinical settings but are prevalent following trauma or surgery.

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