Use of processed nerve allograft to relieve pain and restore function in individuals with painful upper limb neuroma-a case series of five individuals.

Introduction: A traumatic nerve injury that is improperly treated or left untreated may result in a painful neuroma with compromised sensory and motor function. Affected individuals might be hesitant to donate a healthy nerve for an autologous nerve graft procedure. The use of processed nerve allografts (PNA) to reconstruct nerve injuries with painful neuromas is less often discussed. We aim to offer perspectives on treating painful neuromas with PNA when autograft reconstruction is considered not an option. Methods: This series involves five individuals with neuroma formation and varying pain and functional impairment after injuries to different upper limb nerves, i.e., two median nerves at the elbow level, two digital nerves (thumb and little finger), and an isolated ulnar motor branch. Surgery was indicated for pain, not essentially for functional improvement. Treatment decisions were based on patients' symptoms and disability, injury location and nature, time since injury, and previous surgeries. No other options were considered other than neuroma reconstruction with PNA (length of PNA 25-70 mm). Various clinical and electrophysiological methods were used to evaluate outcomes. Results: Four out of five individuals experienced improvement after surgery in pain at rest and during activity, but they still had pain during percussion (Tinel's test). Some sensory and motor functions improved, as assessed by clinical and electrophysiological observations. One individual reported ongoing problems, mainly pain and sleep difficulties, and was subsequently referred to a pain clinic. Discussion: Using PNA for reconstruction may be a suitable solution to relieve pain and improve some function in individuals with painful upper limb neuromas, when autologous nerve grafting is not an option, and even when conducted a long time after the initial nerve injury.