Ann Rehabil Med.  2012 Jun;36(3):404-408. 10.5535/arm.2012.36.3.404.

Sonographically Guided Alcohol Injection in Painful Stump Neuroma

• Lim KB
• Kim YS
• Kim JA

• KMID: 2266748
• DOI: http://doi.org/10.5535/arm.2012.36.3.404

Abstract

Stump neuroma is a common cause of pain from disorganized proliferation of nerve fascicles occurring after limb amputation. Ultrasound guided alcohol injection in painful stump neuroma has been tried as a new treatment approach. Herein, we report 2 male patients, who had traumatic amputation and claimed severe and diffuse burning pain in the stump area. Neuroma at the distal end of an amputated nerve was clearly identified on sonography. The patients gradually developed increasing severe pain that could not be managed with conservative care. They were treated with neurolysis using alcohol solution. Using ultrasonographical guidance, 1.2 ml of 100% dehydrated alcohol was injected into the nerves proximal to neuroma. No complications occurred. The patients were initially pain free. After a few months, however, their stump pain recurred slightly. Repeat neurolysis was performed using 0.3 ml of 100% dehydrated alcohol. During the three months follow-up period, mild stump pain occurred but the patients did not require any analgesics.

Keyword

Stump neuroma; Sonography; Alcohol neurolysis

MeSH Terms

Amputation
Amputation, Traumatic
Analgesics
Burns
Extremities
Follow-Up Studies
Humans
Male
Neuroma
Analgesics

Figure

• 

  Fig. 1 Transverse sonographic images show the stump neuroma, observed as ovoid and hypoechoic structure.

• 

  Fig. 2 Longitudinal sonographic image shows guided needle into the stump neuroma.

• 

  Fig. 3 Longitudinal sonographic images show the stump neuroma, observed as ovoid and hypoechoic structure.

• 

  Fig. 4 Longitudinal sonographic image shows guided needle into the stump neuroma.

Reference

1. Fischler AH, Gross JB. Ultrasound-guided sciatic neuroma block for treatment of intractable stump pain. J Clin Anesth. 2007; 19:626–628. PMID: 18083479.

2. Ernberg LA, Adler RS, Lane J. Ultrasound in the detection and treatment of a painful stump neuroma. Skeletal Radiol. 2003; 32:306–309. PMID: 12719933.

3. Gruber H, Kovacs P, Peer S, Frischhut B, Bodner G. Sonographically guided phenol injection in painful stump neuroma. AJR. 2004; 182:952–954. PMID: 15039170.

4. Fanucci E, Masala S, Fabiano S, Perugia D, Squillaci E, Varrucciu V, Simonetti G. Treatment of intermetatarsal Morton's neuroma with alcohol injection under US guide: 10-month follow-up. Eur Radiol. 2004; 14:514–518. PMID: 14531002.

5. Hughes RJ, Ali K, Jones H, Kendall S, Connell DA. Treatment of Morton's neuroma with alcohol injection under sonographic guidance: follow-up of 101 cases. AJR. 2007; 188:1535–1539. PMID: 17515373.

6. Hyer CF, Mehl LR, Block AJ, Vancourt RB. Treatment of recalcitrant intermetatarsal neuroma with 4% sclerosing alcohol injection: a pilot study. J Foot Ankle Surg. 2005; 44:287–291. PMID: 16012436.

7. Lewin-Kowalik J, Marcol W, Kotulska K, Mandera M, Klimczak A. Prevention and management of painful neuroma. Neurol Med Chir (Tokyo). 2006; 46:62–67. PMID: 16498214.

8. Thomas AJ, Bull MJ, Howard AC, Saleh M. Peri operative ultrasound guided needle localisation of amputation stump neuroma. Injury. 1999; 30:689–691. PMID: 10707244.

9. Lin EE, Horasek S, Agarwal S, Wu CL, Raja SN. Local administration of norepinephrine in the stump evokes dose-dependent pain in amputees. Clin J Pain. 2006; 22:482–486. PMID: 16772803.

10. Valle M, Zamorani MP. Bianchi S, Martinoli C, editors. Nerve and vessels. Ultrasound of the musculoskeletal system. 2007. 1st ed. New York: Springer-Verlag;p. 97–122.