Surgical Management of Digital Neuromas: A Systematic Review of Techniques, Outcomes, and Pain Relief
Year: 2026
Type: review
Study design: Systematic Review
Abstract: BACKGROUND: Painful digital neuromas are disorganized nerve proliferations that develop following traumatic or iatrogenic digital nerve injury, often resulting in debilitating allodynia, hypersensitivity, and impaired hand function. While conservative therapies such as desensitization, splinting, and pharmacological agents may offer temporary relief, over 50% of patients ultimately require surgical intervention. However, surgical strategies remain highly heterogeneous, and no consensus exists regarding the most effective operative technique. METHODS: A comprehensive search of 4 databases through May 2025 identified 30 studies encompassing over 600 adult patients who underwent surgical treatment for digital neuromas. Techniques assessed included neuroma excision with nerve stump transposition, direct end-to-end neurorrhaphy, nerve capping, regenerative peripheral nerve interface (RPNI) surgery, and targeted muscle reinnervation (TMR) surgery. RESULTS: Excision with transposition relieved pain in up to 80% of cases but demonstrated inconsistent sensory recovery. Neurorrhaphy was associated with superior functional outcomes and a reduced recurrence rate. Nerve capping and polyglycolic acid-collagen conduits significantly improved pain scores and protective sensation. RPNI and TMR surgery, though reported in small series, provided over 80% pain relief with minimal complications. Meta-analysis was precluded by outcome heterogeneity. CONCLUSION: Surgical treatment of painful digital neuromas provides meaningful pain relief and functional improvement, particularly when techniques restore physiologic targets for regenerating axons rather than relying on excision alone. Continuity-restoring and reinnervation-based approaches, including neurorrhaphy, nerve capping, RPNI, and TMR, demonstrate favourable outcomes with lower recurrence rates, although comparative evidence remains limited. Standardised outcome measures and higher-quality comparative studies are required to guide optimal, patient-specific surgical decision-making.
Source: Hand
Authors: Omar Shadid, Raj Saini, Jennifer Novo, Ishith Seth, Yi Mon, Bryan Lim, Gianluca Marcaccini, Warren M. Rozen
Institutions: Peninsula Health, Simon Fraser University, University of Siena
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7118087770