Clinical and ultrasound characteristics of post-amputation neuromas in patients with traumatic amputations

BACKGROUND: This study is relevant due to the high prevalence of blast injuries and limb amputations in combat zones and areas affected by terrorism. Post-amputation neuromas are among the most common and severe complications of limb amputation, as they can cause marked pain, sensory and motor impairments, and significantly reduce the quality of life. Ultrasound imaging is used for timely and accurate diagnosis of post-amputation neuromas, particularly for evaluating their clinical and ultrasound characteristics. This enables selection of the most effective treatment and preventive strategies.

AIM: This study aimed to determine the clinical and imaging characteristics of nerve trunks after limb amputation, as well as to identify the structural features of post-amputation neuromas.

METHODS: A premium-class portable Viamo ultrasound scanner (Canon/Toshiba, Japan) was used with a 58-mm linear transducer (frequency range 5–12 MHz). Ultrasound examinations were performed without preparation and included B-mode scanning in longitudinal and transverse planes, with color coded Doppler flow mapping. The nerves of the injured limb and the intact limb were examined. Peripheral limb nerves were examined using a standard ultrasound protocol. The study parameters included nerve trunk contour integrity, echostructure, and echogenicity; trunk size and shape; the presence of a terminal neuroma, its shape, longitudinal dimension, diameter, and cross-sectional area; and the distance from the neuroma to the distal end of the stump. Standard ultrasound software was used for image processing and measurements.

RESULTS: Post-amputation neuromas were detected in at least one nerve in 38 of 40 patients. A total of 53 neuromas were identified in 45 post-amputation stumps. In 12 patients, two or more neuromas were identified in the proximal portion of the amputated limb. We evaluated changes in echogenicity and echostructure of the proximal nerve segments in amputated limbs, regardless of the size of the affected area.

CONCLUSION: Ultrasound imaging of peripheral nerves is a valuable diagnostic tool that quickly evaluates the condition of the nerve trunk and its clinical and morphological characteristics, and it does not require special patient preparation. Ultrasound imaging may also be used to prevent phantom limb syndrome after amputation and to evaluate stump deformity when designing prosthetics.