A case of subcutaneous neuroma presenting with intractable pain and allodynia over the anteromedial aspect of the knee

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3 Citations (Scopus)

Abstract

Introduction: With the exception of interdigital neuromas, cutaneous neuromas are relatively rare and often present a diagnostic challenge. Case Report: We describe a case of a 30-year-old man with a 9-month history of intractable pain and touch allodynia on the medial side of his proximal left leg. Although the exact focus of the pain and allodynia was initially difficult to detect, a subsequent thorough physical examination revealed touch allodynia in a 1×1-cm area overlying the proximal tibia, immediately below the left patella. Ultrasonography of this site with a 7.5-MHz linear probe showed a 2×4-mm round hypoechoic mass with smooth margins that was suspected to be a neuroma arising from the infrapatellar branch of the saphenous nerve. An excisional biopsy was then performed, the pathology of which revealed perineurial thickening, inflammatory cells in the perineurium, and neovascularization, consistent with neuroma. All symptoms disappeared immediately after an excisional biopsy. Conclusions:: The diagnosis of cutaneous neuroma should be considered in all patients who have intractable pain and allodynia at unusual locations and in atypical patterns. In addition, ultrasonography can prove very useful in the detection of small cutaneous neuromas if the site of symptoms can be precisely localized.

Original languageEnglish
Pages (from-to)635-638
Number of pages4
JournalClinical Journal of Pain
Volume28
Issue number7
DOIs
Publication statusPublished - 2012 Sep 1

Fingerprint

Neuroma
Intractable Pain
Hyperalgesia
Knee
Touch
Skin
Ultrasonography
Biopsy
Patella
Tibia
Peripheral Nerves
Physical Examination
Leg
Pathology
Pain

Keywords

  • allodynia
  • cutaneous neuroma
  • excisional biopsy
  • knee
  • pain
  • ultrasonography

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology

Cite this

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title = "A case of subcutaneous neuroma presenting with intractable pain and allodynia over the anteromedial aspect of the knee",
abstract = "Introduction: With the exception of interdigital neuromas, cutaneous neuromas are relatively rare and often present a diagnostic challenge. Case Report: We describe a case of a 30-year-old man with a 9-month history of intractable pain and touch allodynia on the medial side of his proximal left leg. Although the exact focus of the pain and allodynia was initially difficult to detect, a subsequent thorough physical examination revealed touch allodynia in a 1×1-cm area overlying the proximal tibia, immediately below the left patella. Ultrasonography of this site with a 7.5-MHz linear probe showed a 2×4-mm round hypoechoic mass with smooth margins that was suspected to be a neuroma arising from the infrapatellar branch of the saphenous nerve. An excisional biopsy was then performed, the pathology of which revealed perineurial thickening, inflammatory cells in the perineurium, and neovascularization, consistent with neuroma. All symptoms disappeared immediately after an excisional biopsy. Conclusions:: The diagnosis of cutaneous neuroma should be considered in all patients who have intractable pain and allodynia at unusual locations and in atypical patterns. In addition, ultrasonography can prove very useful in the detection of small cutaneous neuromas if the site of symptoms can be precisely localized.",
keywords = "allodynia, cutaneous neuroma, excisional biopsy, knee, pain, ultrasonography",
author = "Kim, {Nan Hee} and Kang, {Hyo Jung} and Hong, {Sung Ho} and Park, {Byung Kyu} and Ju-Han Lee and Park, {Jong Woong} and Kim, {Dong Hwee}",
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AU - Kim, Nan Hee

AU - Kang, Hyo Jung

AU - Hong, Sung Ho

AU - Park, Byung Kyu

AU - Lee, Ju-Han

AU - Park, Jong Woong

AU - Kim, Dong Hwee

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N2 - Introduction: With the exception of interdigital neuromas, cutaneous neuromas are relatively rare and often present a diagnostic challenge. Case Report: We describe a case of a 30-year-old man with a 9-month history of intractable pain and touch allodynia on the medial side of his proximal left leg. Although the exact focus of the pain and allodynia was initially difficult to detect, a subsequent thorough physical examination revealed touch allodynia in a 1×1-cm area overlying the proximal tibia, immediately below the left patella. Ultrasonography of this site with a 7.5-MHz linear probe showed a 2×4-mm round hypoechoic mass with smooth margins that was suspected to be a neuroma arising from the infrapatellar branch of the saphenous nerve. An excisional biopsy was then performed, the pathology of which revealed perineurial thickening, inflammatory cells in the perineurium, and neovascularization, consistent with neuroma. All symptoms disappeared immediately after an excisional biopsy. Conclusions:: The diagnosis of cutaneous neuroma should be considered in all patients who have intractable pain and allodynia at unusual locations and in atypical patterns. In addition, ultrasonography can prove very useful in the detection of small cutaneous neuromas if the site of symptoms can be precisely localized.

AB - Introduction: With the exception of interdigital neuromas, cutaneous neuromas are relatively rare and often present a diagnostic challenge. Case Report: We describe a case of a 30-year-old man with a 9-month history of intractable pain and touch allodynia on the medial side of his proximal left leg. Although the exact focus of the pain and allodynia was initially difficult to detect, a subsequent thorough physical examination revealed touch allodynia in a 1×1-cm area overlying the proximal tibia, immediately below the left patella. Ultrasonography of this site with a 7.5-MHz linear probe showed a 2×4-mm round hypoechoic mass with smooth margins that was suspected to be a neuroma arising from the infrapatellar branch of the saphenous nerve. An excisional biopsy was then performed, the pathology of which revealed perineurial thickening, inflammatory cells in the perineurium, and neovascularization, consistent with neuroma. All symptoms disappeared immediately after an excisional biopsy. Conclusions:: The diagnosis of cutaneous neuroma should be considered in all patients who have intractable pain and allodynia at unusual locations and in atypical patterns. In addition, ultrasonography can prove very useful in the detection of small cutaneous neuromas if the site of symptoms can be precisely localized.

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