Targeted Muscle Reinnervation into Lumbrical Muscles for Treatment of Symptomatic Digital Stump Neuroma

Description

In this informative video presentation, Olga Politikou, a consultant hand surgeon at the University Hospital of Zurich, discusses a novel surgical approach for treating painful digital neuromas through targeted muscle reinnervation into lumbrical muscles. The presentation is structured around a detailed case study of a 41-year-old manual worker who sustained a crush injury leading to an index finger amputation and consequent painful stump neuroma. Despite rigorous rehabilitation, the patient experiences persistent neuropathic pain, prompting the surgical intervention.



Politikou outlines the surgical steps, starting from preoperative patient assessment and marking the site of the neuroma, to execution of the surgical procedure under a bloodless field created by an arm tourniquet. She elaborates on the importance of careful dissection to identify the motor entry point of the second lumbrical muscle, enabling precise nerve stimulation to confirm correct nerve identification. Following the excision of the neuroma and shortening of the digital nerve, the procedure culminates in a tension-free coaptation with the motor branch of the lumbrical muscle.



Through additional case examples, she demonstrates the feasibility of this technique for other digital nerves, reporting significant pain reduction in her patients within three months. The video concludes with a statement affirming the potential effectiveness of targeted muscle reinnervation in managing digital neuromas while highlighting the necessity for further studies and a larger patient cohort to validate the findings.

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