Curtis National Hand Center to Study New Surgical Approach to Painful Neuromas

First in Mid-Atlantic Region to Test Efficacy of Regenerative Peripheral Nerve Interface Surgery

BALTIMORE — Dr. Aviram M. Giladi, research director and upper extremity surgeon at the Curtis National Hand Center at MedStar Union Memorial Hospital, is leading a randomized study to determine the efficacy of a novel surgical approach known as regenerative peripheral nerve interfaces (RPNI), over other procedures, for the treatment of chronic, painful neuromas that develop after finger or hand amputations.

A neuroma is a benign but chronically painful nerve scar that can form after any cut, crush, or amputation injury. The damaged nerve naturally attempts to heal itself, but because of the trauma it instead grows into a chaotic, disorganized ball-like growth of nerve cells. The result is a debilitating pain that can even impact areas away from the injury site.

Neuromas can really make a person miserable,” said Dr. Giladi. “Patients can’t use their hands; they lose function and can’t do their jobs. They can’t wear prosthetics.  Most current treatment options are not adequate to relieve the pain.  Depression often follows this chronic pain especially when these patients are no longer able to work or help their families. And certainly, post-traumatic stress disorder from the injury event can accompany these challenges. Quality of life can be substantially impacted by symptomatic neuromas, so there really is a mental health component to the injury and this study will examine that too.”

Approximately one in 15 patients with hand or finger amputations will develop a symptomatic neuroma and more than half of these patients will undergo revision surgery for neuroma, according to a publication in the Journal of Hand Surgery.

Non-surgical efforts to mitigate the pain include steroid injections, transcutaneous electrical nerve stimulation, and medications including opioids; however, these options are rarely adequate for neuroma pain. Other surgical approaches have been tried with overall mediocre outcomes.  Therefore, most surgeons only perform “traction neurectomy” – cutting the nerve short and letting it retract, as treatment for painful neuromas; this approach has up to a 50% failure rate.

Hand surgeons at Curtis National Hand Center have found promise in applying regenerative peripheral nerve interfaces (RPNIs), muscle grafts placed on the injured nerve that serve as targets for the regenerating axons, as a means to promote healthy more natural nerve regrowth and avoid neuromas.  Early findings show that this works approximately 90% of the time to significantly reduce pain.

Prospective data comparing outcomes of this approach against other surgical options are necessary to confirm early findings and determine the best practice. 

Amputees in the year-long study will be randomized to undergo one of two different surgical approaches, traditional “traction neurectomy” or RNPIs, with subsequent monitoring for pain, disability, and mental health improvements post-operatively. Such a rigorous study is uncommon in surgery because of the complexity and logistics but is required before a new treatment can truly be determined to be better than current care.  Additionally, this study is unique in combining surgical outcomes, pain, and other mental health components to truly understand the full experience of the patient ailing from a post-amputation neuroma and associated chronic pain and stress. 

Individuals suffering with symptomatic neuromas are encouraged to call the research team at 410-554-2486, to see if participating in this study is an option for them.

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