Become a Creator today!Start creating today - Share your story with the world!
Start for free
00:00:00
00:00:01
Neuroma
520 Plays4 months ago
Josh and Miranda talk about Neuromas and what you can do to treat these.
Recommended
Transcript
Introduction to Neuromas by Josh and Rand
00:00:06
joshmacd
Hi, I'm Josh McDonald.
00:00:07
mmateri
and then random ma material and we are Hand Therapy Academy.
00:00:11
joshmacd
Let's talk about neuromas, all things neuroma related. um First, let's talk about what is a neuroma and what does it do to our, like how do our patients experience those? So, Rand, do you want to give us a little functional description of it?
00:00:24
mmateri
Yeah. So I feel like I just recently I've had a few neuromas and they're all like finger amputation, transmetocarpal amputation. um So that's where I've been seeing a few of them. And I've had lots of, for some reason I've had lots of therapists asking me questions about neuromas.
Understanding Neuromas and Surgical Interventions
00:00:42
mmateri
So I thought it'd be a helpful topic, but basically, In the cases that I'm currently seeing in my clinic, it's where the nerve has been transected and um the nerve basically just grows like a ball at the end so that tissue just balls up and reforms the neuroma. So, ulma means mass or ball and the nerve is the nerve, right? So, a mass or ball of the nerve that has formed. And typically, they're very, very sensitive. So, even if you're going in there and desensitizing it, a lot of times it won't desensitize.
00:01:13
mmateri
um And typically, these patients have to go in and have some type of procedure done. And with neuromas or with the nerves, when they're cut and they're no longer innervating a structure that they're supposed to innervate, the nerve always wants to have a job to do. So when it loses its job, so that being sensing or using a ah motor point that it's um innovating, then it starts to act up. So a lot of some of the newer stuff is doing some surgeries to give the nerve a job to do again, or ah they're still like, of course, burying them, like I've seen them drill holes and burying them in the metacarpal and those things.
00:01:51
mmateri
Is that um kind of your experience with neuromas or older use?
00:01:54
joshmacd
Yeah, yeah, definitely. um And I feel like it it's those traumatic amputations. I haven't seen as many with like a flexor tendon injury where the nerve is still lacerated. I feel like it's the higher trauma patients that are more likely to get them. um I think I've seen some in lesser traumas, but I feel like it's much more common in the the bigger amputations. And I think it's just a nervous system gone haywire and that attempt to grow turns into this ball on the end of the nerve.
00:02:25
mmateri
Yeah.
00:02:25
joshmacd
yeah
00:02:26
mmateri
And i I think like, you know, when you're talking about like flexor tendons and stuff and like say it's a zone two, the surgeon always goes in and, you know, puts the nerve back together. And whether that nerve heals and recovers, I think, um you know, it it oftentimes doesn't. But at least the nerve is like getting the signal and, you know, there's some activity going on. So it's not like stuck without a job to do.
00:02:49
joshmacd
Yeah.
00:02:49
mmateri
And I think that's my theory on why we don't see um as many of those types of injuries versus the ones where therere the fingers are gone, you know the some of the muscle structures are gone, now what what does that
Pain Management Strategies for Neuromas
00:03:01
mmateri
nerve do? It doesn't really serve a purpose anymore.
00:03:02
joshmacd
Yeah.
00:03:03
mmateri
So its purpose is to get irritated and grow.
00:03:07
joshmacd
Yeah, yeah, and it wants to find that purpose, it's, yeah. And I've had some patients in the past where the neuroma was like deep in the thenar eminence or in like maybe P1 of the thumb. And I feel like that is such a high traffic area for use of the hand that I don't know, I'm wondering too, if that like aggravated maybe what was a small neuroma into a much more ah prominent sensation problem.
00:03:27
mmateri
Yeah.
00:03:31
joshmacd
Like it can be agitated into a bigger growth and become like this bigger thing.
00:03:36
mmateri
Right, and then these patients are getting, you know, ah at least at my one clinic, we see a lot of amputees that are work cough related. And so they're getting these great prosthetics, you know, but they oftentimes won't be able to wear them, right? So if we don't identify the neuroma early and take care of it, then they might have $100,000 prosthetic that they can't even wear because of this, you know, pesky neuroma that we're having struggling with.
00:04:01
joshmacd
Yeah, exactly. Exactly.
00:04:03
mmateri
So, go ahead, sorry.
00:04:03
joshmacd
And so, so that's okay. There's a lot of patients, I feel like that we talk about not ignoring pain, but working through pain and like, Oh, that's, it's uncomfortable. I'm sorry. We'll try to desensitize and and work through range of motion. But there comes a time when you realize, hey, this is maybe much more focal of a pain point, and it's not getting better. And the response to that one pain, not like CRPS where the whole global system is turned up in intensity, but that one area, when you start to identify that, hey, that specific spot is lit up. And if I do a centimeter,
00:04:38
joshmacd
and any direction away from it it's really much less sensitive that tells me i shouldn't just try to plow through with it that maybe i need to send them back to the doctor or at their follow-up visit maybe say hey maybe we need to look at this neuroroma and talk to the patient about like really communicate to them like that laser point spot right there is the culprit.
00:04:54
mmateri
Yeah, and then when they do have those neuromas and then we fire that pain response and then we keep firing it and firing and firing it, right? Like if they're trying to wear a prosthetic and it's not desensitizing or not getting better, then you're basically just reinforcing that pain pathway, right? And then once they do, so then even when they go to have the neuroma removed, they still have that pain pathway, even though the neuroma's gone, right? The initial etiology of the pain is gone, But that pathway is still very much
Surgical Advances in Neuroma Treatment
00:05:24
mmateri
active.
00:05:24
mmateri
So I think with these neuroma patients, if you keep firing the pain signal and you don't take care of it early, it creates like this feedback thing where you're like just chasing your tail trying to get rid of it.
00:05:35
joshmacd
Yeah.
00:05:35
mmateri
And I've seen them go in and like bury them in the metacarpal and you're thinking like, how does this neuroma ever grow back? Or how do they still have this pain response? And I think it's very much that pain pathway.
00:05:47
joshmacd
Yeah, yeah. And it at that point, doesn't take much to trigger that response. And then that that upper cortex version of pain perception kicks in. And it's like, oh, my brain remembers that. It's got to be that significant, even if it's just the smallest, slightest stimulus.
00:06:02
mmateri
Yeah. So then I've seen where, like, instead of the surgeon trying to bury it deeper into the soft tissue or into the bone, I've seen where they're now, like, trying to find motor points. You know, like, they use this little e-stem unit. and And I don't think it's an e-stem unit. I don't know what it's called. But they use this little unit to stimulate the motor point when they're in surgery. And then they basically take that nerve um that's causing the problem and co-apt it into
00:06:26
joshmacd
Hmm.
00:06:26
mmateri
ah that muscle point and then the nerve essentially has a new job to do so you're not getting that negative pain pathway.
00:06:34
joshmacd
Interesting okay all right.
00:06:36
mmateri
Yeah, so I think there's like other options and things that are doing it. Honestly, I haven't seen it in my clinical practice.
Role of Therapists in Neuroma Care
00:06:43
joshmacd
Yeah. Yeah. But always new things to learn and and get exposed to because that's the kind of thing that, you know, if if you tell a patient like, Hey, maybe ask your doctor if this is something that could you that could be pursued or if they're kind of kicking back on surgery after surgery on it. Yeah.
00:06:57
mmateri
Yeah, there might be some other options out there. And when I saw that talk, it was a few years ago, so I'm sure there's even more stuff that's come out now. I think it's just finding like the clinics and the surgeons that are doing them.
00:07:09
joshmacd
yeah yeah it's an interesting thing to to Pain is such an interesting concept because we deal with patients who have pain that is hard to define and patients with pain that we understand. And there's patients like this that have pain that is so specific and so focal, and there's really nothing we can do except help them navigate to go get it addressed surgically or with padding or, but like, I can't make that better for you, but I can help you manage the symptoms and and cope with it until we can get it addressed.
00:07:40
mmateri
Yeah. And I think identity, like as therapists, we're with these patients, you know, sometimes two, three hours, right? and A week. So we're the one that has the most contact. And I think sometimes we, you know, we may pick it up just because by default we're with this patient so much so we can be the communicator with the surgeon. So sometimes I'll even go with my patients to their doctor's appointment like, Hey, what do you think about this? Do you think it's an aroma? Is there anything different we should be doing in therapy? And I honestly learn a lot from the surgeon and I also think sometimes they're like, oh, maybe, you know, maybe you're right. Let's take a closer look at it.
00:08:12
joshmacd
Yeah, and I'm always surprised when you coach a patient and say, all right, you want to ask them about this and this and this, and they get back and like, yeah, I forgot all this stuff. Well, did you mention the pain in your hand? No, I forgot about that. I'm like, oh my gosh, that's the most the most impactful thing in your life right now.
00:08:25
mmateri
Or send a note.
00:08:26
joshmacd
How did you forget that one? So sometimes we need to, you know, whether it's a text to the doctor before their session or you go to their session or whatever it is, kind of helping that, yeah, helping that patient.
00:08:36
mmateri
Sometimes they forget the notes though.
00:08:39
joshmacd
Yes, yes, had that happened today, patient forgot to take my note to do the doctor's office.
00:08:42
mmateri
It happens all the time.
00:08:45
joshmacd
Yeah.
00:08:47
mmateri
I'm always like, you know what, I'm just kidding. If it's really, I think it's really crucial. I'm gonna just try to find a way to get there.
00:08:51
joshmacd
Yeah, yeah, yeah, definitely.
Further Resources and Contact Information
00:08:53
joshmacd
Yeah, so more interesting stuff on neuromas. If you guys have thoughts or questions, certainly reach out to us through our email, info at handtherapyacademy or on any of our social media platforms at handtherapyacademy.