hand, foot, chest wall, abdomen, groin & amputation Neuroma Specialist in Pittsburgh, PA
Neuroma Pain & Targeted Muscle Reinnervation (TMR)
A neuroma is a disorganized growth of nerve cells at the site of a nerve injury. A neuroma occurs after a nerve is partially or completely damaged by an injury — either due to a cut, a crush, or an excessive stretch. The neuroma is a ball-shaped mass at the site of the injury, which can be painful or cause a tingling sensation if tapped or if pressure is applied. Although not always the case, a neuroma can be extremely painful and can cause significant loss of function for the patient by limiting motion and contact with the affected area.
Neuromas can occur after trauma and even after surgery in any region in the body since most areas have nerve fibers providing feeling. Painful neuromas are common after cuts to the fingers, hand, wrist, or arm; after surgery to the breast or chest wall, and in amputations of the fingers, hand, and upper extremity (arm) and in the lower extremity (leg). They are also seen following hernia repair in the abdomen or groin, or after knee or ankle surgery.
Pittsburgh’s Top Targeted muscle reinnervation Specialist for amputaTION Nerve Damage
Limb Amputee Neuroma Pain/Phantom Limb Pain/Targeted Muscle Reinnervation
The peripheral nervous system is defined as the nerves outside the spinal canal. When nerves are injured, cut, or pinched, the brain interprets that as pain. Carpal tunnel is one example of a pinching of a peripheral nerve. Neuromas are the result of injury to a peripheral nerve. The nerve tries to heal, but instead develops disorganized nerve and scar tissue. For amputees, the loss of the limb creates many cut or damaged nerves in the amputated stump. Like a live electrical wire, the neuromas that form can cause severe pain in some patients. In amputees, the loss of connectedness of the end of the nerve can also cause unpleasant phantom limb pain.
A procedure called Targeted Muscle Reinnervation, or TMR, gives the injured nerve somewhere to go and something to do. TMR involves rerouting severed or injured nerves to new muscle targets using microsurgical techniques to provide the nerve endings with a new muscle to innervate. The new muscle target encourages the nerve to regenerate in an organized fashion, with improvements in both neuroma pain and phantom limb pain.
neuroma pain Specialist in Pittsburgh
Painful Neuroma Conditions
In addition to treating painful nerves in amputated limbs, Dr. Spiess is an expert at treating a number of other conditions resulting from NeuromaPain, including:
- Breast or Chest Wall Neuroma Pain: Postmastectomy neuroma pain presents as pain in the Breast, Chest wall, or Arm pit, which has been present for at least 3 months. This is most commonly caused by damage to the Intercostal Brachial Nerve. Current treatments include medications (oral and topical), therapy, and nerve blocks. We have successfully treated this condition with surgical excision of the neuroma, when non-operative treatments have failed.
- Painful Foot Nerves: It is not uncommon for patients to have injured nerves around the foot and ankle. The nerves can be compressed around the ankle, and the condition of Tarsal Tunnel is very much like the more common carpal tunnel syndrome, causing pain and foot numbness. Nerves can be injured during tarsal tunnel surgery, or when foot and ankle surgeons approach the bones of the foot. Even some severe ankle twists can injure the foot nerves. Dr. Spiess treats painful nerves of the feet by trying to reconstruct the nerve with a nerve graft, or uses TMR when reconstruction is not possible.
- Painful Abdominal Wall Nerves: There are numerous nerves that serve the abdominal wall. Unfortunately, they can be injured after common surgery approaches the intestines, including after laparoscopy, incisional hernia repairs, or other incisions around the abdomen. When a reconstruction is not possible, Dr. Spiess uses TMR to help treat the neuroma pain.
- Nerve Tumors: Tumors can form on nerves. The most common type of nerve tumor is the Schwannoma or Neurilemmoma. These tumors feel like small marbles under the skin, and tapping them causes pins and needles to go down the limb in the distribution of that nerve. They tend to be straightforward to remove, and their removal does not tend to cause any nerve injury, as they push normal nerves out of the way as they grow. They should be removed in the operating room. Dr. Spiess can evaluate your nerve tumor, discuss if an MRI should be done, and let you know what the chances are for a loss of function from the removal of the tumor.
- Neurofibromas: Neurofibromas are nerve tumors that can infiltrate the nerve. Removal of a neurofibroma can result in partial or total loss of the function of the nerve, requiring reconstruction of the nerve with a nerve graft at the time of tumor removal. Some patients can have numerous neurofibromas, and that syndrome is called von Recklinghausen’s disease. Rarely, a neurofibroma can become painful at rest—in these situations the neurofibroma can be degenerating into a cancer, and it must be removed.
- Pain After Groin Hernia Repair: 1/20 people will experience chronic groin pain after the treatment of an inguinal hernia. Dr. Spiess performs neuroma excision and targeted muscle reinnervation procedure to treat chronic localized pain after inguinal hernia repair. In the office, Dr. Spiess will often inject local anesthesia to numb the area as a test to see if you are a good candidate for surgery.
Frequently Asked Questions
Can neuroma excision be used to treat pain after groin hernia surgery?
1/20 people will experience chronic groin pain after the treatment of an inguinal hernia. Dr. Spiess performs neuroma excision to treat chronic localized pain after inguinal hernia repair. In the office, Dr. Spiess will often inject local anesthesia to numb the area as a test to see if you are a good candidate for surgery.
How do I know if TMR will work for me?
Alexander Spiess, MD is a specialist in Targeted Muscle Reinnervation, and he has the expertise to determine whether TMR will help you find relief from pain due to nerve damage. When you have your first consultation with Dr. Spiess, he will review your medical history, your condition, and your unique needs and goals in order to help you decide whether or not to pursue TMR.