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Hand Trauma – Soft Tissue
Published in Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal, Plastic Surgery for Trauma, 2022
Dorian Hobday, Ted Welman, Maxim D. Horwitz, Gurjinderpal Singh Pahal
Divided nerves (neurotmesis) require urgent formal surgical repair under magnification within 4 days of injury for digital nerves [o] or within 3 days for major nerves of the upper limb. Digital nerves can be repaired on an outpatient basis. Patients with major nerve injuries should be admitted and managed as inpatients. If left unrepaired for any significant time nerves retract, making primary repair difficult. Neuroma may also occur.
Forefoot disorders
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Morton described a case series in 1876 comprising of patients with pain in the toes especially in the 3rd and 4th toes, some of which were relieved by excision of the metatarsal head. Since then the interdigital neuroma has been commonly known as a Morton's neuroma. It is not a true neuroma but thickening of the digital nerve due to perineural fibrosis, demyelination and neural oedema. Predominantly, it affects the third web space. This is likely due to the fact that the third interdigital nerve is formed by the confluence of branches from the medial and lateral plantar nerves (hence, slightly less mobile).
Surgery of the Peripheral Nerve
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Ravikiran Shenoy, Gorav Datta, Max Horowitz, Mike Fox
When nerves have been damaged and surgery has been delayed, a neuroma will have formed. The consistency of a neuroma is important when assessing nerve injury, as a hard neuroma may represent an abundance of connective tissue and little in the way of nerve tissue. Making an incision through the damaged epineurium permits visualisation of any nerve bundles present, and stimulation of the nerve proximally. This may give some indication as to likely recovery. Stimulating the nerve proximally and recording from the nerve distally give the best guide for recovery. An absence of recording distally is a relative indication to resect and repair the nerve, depending on the macroscopic fascicular structure seen. Care should be taken not to undertake excessive mobilisation, as this may lead to devascularisation of a nerve.
Treatment of painful median nerve neuroma using pedicled vascularized lateral antebrachial cutaneous nerve with adipofascial flap: a cadaveric study and exploration of clinical application
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Kenji Kawamura, Shohei Omokawa, Naoki Maegawa, Yasuaki Nakanishi, Takamasa Shimizu, Mitsuyuki Nagashima, Hideo Hasegawa, Hiroshi Okada, Kanit Sananpanich, Pasuk Mahakkanukrauh, Yasuhito Tanaka
Median nerve injuries at the wrist are common and result from lacerations, motor vehicle accidents, and iatrogenic mishap during carpal tunnel release procedures [1,2]. Painful neuromas can develop even after microsurgical repair of a median nerve injury or when the lesion is underestimated and therefore not adequately repaired [3]. The treatment of painful neuromas aims to both minimize pain and restore the function of the median nerve. Different techniques have been introduced to treat painful median nerve neuromas, and there has been no one way that is completely effective in the treatment [4]. One of the newer methods for treatment of median neve neuromas is coverage of the neuromas with vascularized soft tissue following external neurolysis [5–7]. This procedure can improve nutrition delivery to the nerve, restrict the degree of scar adhesion, and prevent the nerve lesion from resting in a vulnerable position close to the skin surface [8,9].
Management of acute lesser toe pain
Published in Postgraduate Medicine, 2021
Jessyca Ray, Nicholas A. Andrews, Aseel Dib, Whitt M. Harrelson, Ankit Khurana, Maninder Shah Singh, Ashish Shah
The primary principles of conservative management in Metatarsalgia, Interdigital Neuroma, and Freiburg Infraction focus on metatarsal unloading and avoidance of constricting footwear. Orthotics and shoe inserts with metatarsal pads reduce the load on the metatarsal heads, and short courses of non-steroidal anti-inflammatories can be utilized to decrease pain and possible swelling (Figure 5) [7,20,21]. Patient education on shoe choice is an important first step as footwear can easily cause or exacerbate symptomatology. Optimal shoes should be the proper length with large toe-boxes, flat heels, and rigid, thick outer soles. These shoe modifications alleviate pain by evenly distributing the weight-bearing load and pressure across the sole of the foot and avoid constricting the interdigital space [8,20–24]. Patients with metatarsalgia can also benefit from stretching programs to target tight gastrocnemius muscles. While local anesthetic injections, which provide temporary pain relief, and local steroid injections can be used in patients with an interdigital neuroma [8,24]. Lastly, reduced physical activity is recommended in patients with Freiburg Infarction [28].
Balance training versus balance training and foot and ankle mobilization: a pilot randomized trial in community-dwelling older adults
Published in Physiotherapy Theory and Practice, 2020
David Hernández-Guillén, Alejandro Sanoguera-Torres, Carlos Martínez-Pérez, Celedonia Igual-Camacho, José-María Blasco
In this context, some authors have suggested that foot and ankle mobilization (FAM) techniques may be used as a therapeutic method to correct these limitations, either by restoring mobility, stimulating the proprioceptive system, or by optimizing biomechanical functioning (Chevutschi, D’houwt, Pardessus, and Thevenon, 2015; Gong, Park, and Ma, 2011; Pertille et al, 2012). The technique has showed beneficial effects in different populations for the treatment of diverse conditions, such as chronic ankle instabilities, sprains, or Morton’s neuromas, among others (McKeon and Wikstrom, 2016; Queen, 2017; Sault, Morris, Jayaseelan, and Emerson-Kavchak, 2016; Weerasekara et al, 2018). Given the positive association between balance and ankle ROM in older adults (Mecagni, Smith, Roberts, and O’Sullivan, 2000), we speculated that FAM techniques could also improve balance of older adults with ankle mobility limitations.