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Neuroma ASPN 2019 Diagnostic Criteria for Symptomatic Neuroma Denise MJ Arnold, MD; Suzanne C Wilkens, MD; Neal C Chen, MD; Ivica Ducic, MD, PhD; Kyle R Eberlin, MD Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School Year Authors Type of article No. Pts/Studies Body part Type of injury Anamnesis Mentioned diagnostics 2018 Lu et all. Literature review - NS NS Allodynia, hyperesthesia Tinel sign, histology 2017 Dahlin et all. Literature review - Upper extremity and hand Traumatic Localized pain, sensory disturbances, allodynia, hyper- Tinel sign, US/MRI Aim /dysesthesia, cold sensitivity 2017 Vlot et all. Retrospective cohort 1083 Fingers Amputation Sharp/burning pain, cold intolerance Shooting, electrical sensation elicited by direct pressure 2017 Poyntz et all. Systematic review 22 Lower extremity Amputation Localized tenderness, electric pain, mechanical and Sensitive palpable lump, Tinel sign, diagnostic To review existing literature on the diagnostic criteria for symptomatic neuroma, and develop criteria for the clinical diagnosis of chemosensitivity lidocaine nerve block, US, histology 2017 Decrouy-Duruz et all. Retrospective cohort 231 Whole body Surgical Burning/tingling/sharp/ stabbing pain, anesthesia, Tinel sign, diagnostic nerve block symptomatic neuroma. hypesthesia, allodynia, hyperalgesia, dysesthesia 2017 Schwarz et all. Review of current concepts - Brachial plexus Traumatic - Tinel sign, US 2017 Aydemir et all. Retrospective chart review 147 Lower extremity Amputation - Tinel sign, US Conclusion 2016 O’Reilly et all. Retrospective review 80 Upper and lower extremity Amputation Localized pain, altered sensation Tinel sign, US 2016 Toia et all. Retrospective cohort 108 Upper and lower extremity Entrapment, tumoral, - Tinel sign, US traumatic, surgical 2015 Duzcu et all. Case report 1 Lower extremity Amputation Pain Soft tissue mass, Tinel sign, CT/US/MRI, histology The diagnosis of symptomatic neuroma is based on a history of (suspected) nerve injury, symptoms in a defined neural anatomic 2015 Wojtkiewicz et all. Retrospective cohort 490 Upper and lower extremity NS Stabbing/throbbing/ shooting pain, QoL scores - 2015 Martins et all. Case series 7 Fingers Amputation Allodynia, paresthesia, dysesthesia, chronic pain Local tenderness, Tinel sign, diagnostic lidocaine distribution and most importantly pain. In combination with a positive Tinel sign, positive response to a diagnostic local anesthetic spontaneous pain nerve block 2014 Jung et all. Prospective randomized 2x15 Upper and lower extremity Amputation Neuropathic pain, hyperalgesia, allodynia Tinel sign, US experiment and control injection, or US or MRI confirmation of neuroma, these criteria form the basis of diagnosis of symptomatic neuroma. 2014 Chabra et all. Review of current concepts - NS NS - Tinel Sign, MRI 2014 Abraham et all. Case report 1 Finger Amputation Sharp, unremitting pain Tender soft tissue mass, Tinel sign 2014 Pet et all. Retrospective case control 35 Upper and lower extremity Amputation - Local tenderness, Tinel sign 2014 Souza et all. Retrospective cohort 26 Upper extremity Amputation Localized nerve pain Physical findings consistent with localized nerve 1. Introduction 2. Methods 3. Results pain (NS) 2013 Brogan et all. Literature review - Upper extremity Traumatic Pain related to a single peripheral nerve distribution, Tinel, diagnostic nerve block, US/MRI hypoesthesia 2013 Daniilidis et all. Case report 1 Lower extremity Amputation Localized burning pain Local pressure pain, diagnostic bupivacaine nerve • Neuromas occur in 5-10% of patients Design: block, MRI Diagnostic Criteria for 2013 O’Reilly et all. Retrospective review 133 Upper and lower extremity Amputation - Local tenderness, US, Tinel sign sustaining a nerve injury, especially after • Systematic review following the 2013 Van der Avoort et all. Retrospective cohort 583 Fingers Amputation, neurorrhaphy Burning/shooting/electrical/rather Tinel sign, histology Symptomatic Neuroma deep/aching/throbbing pain, tight feeling amputation. They are often difficult to 2009 PRISMA guidelines 2013 Hsu et all. Literature review - NS Amputation Mechanical sensitivity, pain, abnormal sensation, cold Tinel sign intolerance Must have all 3: 2013 Abreu et all. Review of current concepts - NS Traumatic Pain Tinel sign, firm soft tissue mass, histology, treat and may cause significant morbidity. • Pubmed, Embase, Cochrane Library CT/US/MRI 2012 Lim et all. Case series 2 Lower extremity Amputation Analgesic-resistant pain, hyperalgesia, hyperpathia, US, biopsy/fine needle aspiration, pressure • Screening by title and abstract triggering test (Tinel) 1. Pain with at least 3 of the following characteristics: 2012 Rajput et all. Literature review 100 NS NS Stabbing/throbbing/burning/ cramping pain, Tinel sign, US/CT/MRI • Diagnosis has traditionally been made • Eligibility assessed by full article hyperalgesia, allodynia, hypoesthesia, hyperalgesia, burning, sharp, shooting, electric, paresthesias, anesthesia based on patient history, symptoms, 2011 Ducic et all. Literature review 38 Upper and lower extremity Surgical Medication-resistant pain Tinel sign, diagnostic nerve block numbness, cold intolerance 2011 Zhu et all. Prospective cohort 202 Upper and lower extremity Traumatic - Neurological examination and electrodiagnostic tests, US physical examination, and location and Inclusion: 2011 Restrepo-Garces at all. Case report 1 Lower extremity Throbbing/burning/squeezing/stabbing/electrical pain Tinel sign, US, diagnostic levo-bupivacaine nerve 2. Symptoms in a defines neural anatomic distribution block distribution of pain, sometimes supported • All articles addressing neuroma 2011 Stokvis et all. Review of current concepts - NS Traumatic or iatrogenic Spontaneous electric/shooting/burning pain, allodynia, Tinel sign, diagnostic lidocaine nerve block, 3. History of nerve injury or suspected nerve injury hyperalgesia, hypoesthesia, paresthesia, cold monofilament and 2-point discrimination tests, US by a Tinel sign, imaging, and response to after nerve injury and amputation intolerance 2010 Watson et all. Review of current concepts - Hand and upper extremity Traumatic or iatrogenic Substantial stabbing/ throbbing/burning/cramping pain, Tinel sign altered sensation, hypoesthesia, hyperalgesia, a nerve block. • Languages: English, Dutch, German anesthesia Must have at least 1: 2010 Chhabra et all. Review of current concepts, 8 Upper and lower extremity Surgical, amputation, Disabling pain, sensory changes Tinel sign, denervation atrophy of the muscles, case series traumatic MRI 2010 Nikolajsen et all. Randomized controlled 6 Hands Amputation, surgical Medication-resistant pain, allodynia, hyperalgesia, Tinel sign, quantitative sensory testing: brush- • There are no established or formally Exclusion: blinded prospective case cold/heat intolerance evoked allodynia, tactile/pressure pain/ thermal 1. Positive Tinel sign (for cutaneous nerve) series thresholds 2010 Stokvis et all. Prospective cohort 34 Upper extremity Traumatic, iatrogenic Spontaneous electrical spike/burning pain, allodynia, Tinel sign, diagnostic lidocaine nerve block, accepted diagnostic criteria for • Duplicates hyperalgesia DASH, CISS (cold intolerance) 2. Positive response to local anesthetic injection 2009 Stokvis et all. Prospective cohort 34 Upper extremity Traumatic, iatrogenic Intense pain, altered sensation, mechanical Tinel sign, diagnostic lidocaine nerve block, symptomatic neuroma. • Non-human studies (sub analysis focusing on hyperalgesia, cold intolerance DASH, CISS (cold intolerance) 3. US or MRI conformation of neuroma cold intolerance) • Non-extremity neuromas 2009 Shankar Case report 1 Lower extremity Amputation Sharp, intermittent, lancinating, sometimes radiating Tinel sign, diagnostic lidocaine nerve block, US pain 2009 Sehirlioglu et all. Retrospective cohort 75 Lower extremity Landmine explosion - Soft tissue mass, Tinel sign, diagnostic lidocaine • Morton’s neuroma, bowler’s thumb amputation nerve block, US/MRI 2008 Ducic et all. Retrospective chart review 21 Upper and lower extremity Amputation Pain, paresthesia Tinel sign, diagnostic nerve block 2008 Gruber et all. Prospective cohort 82 Upper and lower extremity Amputation Dull aching pain, paroxysmal sharp flashing staccato- Tinel sign, diagnostic lidocaine nerve block, US like pain Identification Screening Eligibility Included 2007 Cokluk et all. Prospective case series 36 Upper extremity Traumatic - US 2006 Lin et all. Prospective single blinded 20 Upper and lower extremity Amputation Throbbing/burning/squeezing pain, pins and needles, Local tenderness, Tinel sign, pain elicited by local cohort cold intolerance administration of norepinephrine Records identified Records screened on Full-text articles Studies included in Studies included in 2006 Zhang et all. Case report 1 Finger Amputation Chronic pain, cold intolerance, hypersensitivity Tinel sign, histology Duplicates 2004 Cokluk et all. Prospective case series 14 Upper and lower extremity Traumatic - US through database title/abstract assessed for eligibility qualitative synthesis quantitative synthesis (subset of 2007 study) (n = 42) 2004 Koch et all. Case series 8 Lower extremity Amputation, surgical - Tinel sign, diagnostic lidocaine nerve block searching (n = 778) (n = 737) (n = 91) (n = 50) (n = 50) (subset of 2003 study) 2003 Koch et all. Case series 23 Upper and lower extremity Amputation, surgical - Tinel sign, diagnostic lidocaine nerve block 1999 Thomas et
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