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  3. Algorithm For Surgical Management Of Symptomatic Hand And Digital Neuromas.
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  3. Algorithm For Surgical Management Of Symptomatic Hand And Digital Neuromas.

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Algorithm for Surgical Management of Symptomatic Hand and Digital Neuromas.

Maximilian Mayrhofer-Schmid1,2,3, Niek J Nieuwdorp2,4, Devin J Clegg1

  • 1From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Plastic and Reconstructive Surgery. Global Open
|June 25, 2026

View abstract on PubMed

Summary
This summary is machine-generated.

This study offers a practical, anatomy-driven algorithm for surgical treatment of hand neuromas. It guides surgeons on choosing between reconstructive and nerve-end management techniques for better patient outcomes.

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Area of Science:

  • Hand surgery
  • Peripheral nerve injury
  • Neuroma treatment

Background:

  • Symptomatic neuromas in the hand cause significant pain and functional loss.
  • Surgical options for neuromas have evolved from passive to active techniques.
  • A clear guide for selecting surgical approaches for hand neuromas is lacking.

Purpose of the Study:

  • To develop a pragmatic, anatomy-driven algorithm for surgical decision-making in hand neuroma treatment.
  • To integrate findings from a scoping review with established peripheral nerve surgery principles.
  • To provide a clear overview of surgical options for symptomatic neuromas distal to the wrist.

Main Methods:

  • Conducted a scoping review of surgical treatments for symptomatic neuromas distal to the wrist.
  • Integrated review findings with established peripheral nerve surgery principles.
  • Developed an anatomy-driven treatment algorithm to guide operative decisions.

    • Main Results:

    • Literature on neuroma surgery is largely retrospective with varied techniques and outcomes.
    • Many patients experience pain improvement after surgery, but direct technique comparisons are limited.
    • The algorithm prioritizes reconstruction (primary repair or interposition) when feasible; otherwise, it details nerve-end management options.

    Conclusions:

    • A structured approach can streamline the evaluation and treatment selection for hand neuromas.
    • The proposed algorithm offers a reproducible pathway for contemporary surgical management.
    • This framework supports practical considerations for managing hand and digital neuromas.