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Neuromas are a substantial cause of morbidity and reduction in quality of life. This is not only caused by a disruption in motor and sensory function from the underlying nerve injury but also by the debilitating effects of neuropathic pain resulting from symptomatic neuromas. A wide range of surgical and therapeutic modalities have been introduced to mitigate this pain. Nevertheless, no single treatment option has been successful in completely resolving the associated constellation of symptoms. While certain novel surgical techniques have shown promising results in reducing neuroma-derived and phantom limb pain, their effectiveness and the exact mechanism behind their pain-relieving capacities have not yet been defined. Furthermore, surgery has inherent risks, may not be suitable for many patients, and may yet still fail to relieve pain. Therefore, there remains a great clinical need for additional therapeutic modalities to further improve treatment for patients with devastating injuries that lead to symptomatic neuromas. However, the molecular mechanisms and genetic contributions behind the regulatory programs that drive neuroma formation—as well as the resulting neuropathic pain—remain incompletely understood. Here, we review the histopathological features of symptomatic neuromas, our current understanding of the mechanisms that favor neuroma formation, and the putative contributory signals and regulatory programs that facilitate somatic pain, including neurotrophic factors, neuroinflammatory peptides, cytokines, along with transient receptor potential, and ionotropic channels that suggest possible approaches and innovations to identify novel clinical therapeutics. [ABSTRACT FROM AUTHOR]

Background:  Targeted muscle reinnervation (TMR) is an effective surgical treatment of neuropathic pain for amputees. However, limited data exist regarding the early postoperative pain course for patients who undergo either primary (<14 days since amputation) or secondary (≥14 days) TMR. This study aims to outline the postoperative pain course for primary and secondary TMR during the first 6 postoperative months to aid in patient education and expectation management., Methods:  Patients were eligible if they underwent TMR surgery between 2017 and 2023. Prospectively collected patient-reported outcome measures of pain scores, Pain Interference, and Pain Intensity were analyzed. Multilevel mixed-effects models were utilized to visualize and compare pain courses between primary and secondary TMR patients., Results:  A total of 203 amputees were included, with 40.9% being primary and 59.1% being secondary TMR patients. Primary TMR patients reported significantly lower pain scores over the full 6-month postoperative trajectory ( p  < 0.001) compared with secondary TMR patients, with a difference of Δ -1.0 at the day of TMR (primary = 4.5, secondary = 5.5), and a difference of Δ -1.4 at the 6-month mark (primary = 3.6, secondary = 5.0). Primary TMR patients also reported significantly lower Pain Interference ( p  < 0.001) and Pain Intensity scores ( p  < 0.001) over the complete trajectory of their care., Conclusion:  Primary TMR patients report lower pain during the first 6 months postoperatively compared with secondary TMR patients. This may reflect how pre-existing neuropathic pain is more challenging to mitigate through peripheral nerve surgery. The current trends may assist in both understanding the postoperative pain course and managing patient expectations following TMR., Level of Evidence:  Therapeutic - IV., Competing Interests: None declared., (Thieme. All rights reserved.)

Objectives: The prevalence of tendinopathic changes of the distal biceps tendon (DBT) is not clear, in both the general population and patients with symptoms that may be related to distal biceps tendinopathy. The purpose of this study is to retrospectively determine the prevalence of distal biceps tendinopathy in symptomatic and asymptomatic patients undergoing an MRI of the elbow. A secondary aim is to assess the association between age and the prevalence of incidental distal biceps tendinopathy., Methods: We assessed 1,180 MRI-reports describing the elbow region and calculated prevalence of incidental and symptomatic DBT tendinopathies. Symptomatic DBT tendinopathy was defined as patients that had complaints of anterior elbow pain. With a multivariate logistic regression analysis we tested whether age, sex, and race were independently associated with DBT tendinopathy., Results: 276 of 1,180 (23%) of the distal biceps tendons showed signal changes on the MRI. Only 114 (10%) showed DBT tendinopathy, of which60 (5% of all tendons, 53% of tendons with tendinopathy) were incidental. The prevalence peaked between 40-49.9 years (37%) and 50-59.9 years (30%). There was no significant association between increasing age and incidental DBT tendinopathy (P= 0.935). However, there was a significant association between increasing age and tendinopathy, whether the tendinopathy was incidental or symptomatic (P< 0.001)., Conclusion: Signal changes in the DBT are common on MRI scans, however 53% of detected tendinopathies are incidental. There is no association between increasing age and prevalence of incidental DBT tendinopathy, though there is a significant association between increasing age and DBT tendinopathy., Competing Interests: None of the authors have commercial relations that might pose a conflict of interest in connection with the manuscript. No direct funding was received for this study., (Copyright © 2024 Mashhad University of Medical Sciences.)