Excision of neuroma; digital nerve, 1 or both, same digit
CPT4 code
Name of the Procedure:
Excision of Neuroma; Digital Nerve, 1 or Both, Same Digit
Common Name(s): Neuroma removal, Digital nerve surgery
Technical Terms: Neuroma excision, Digital nerve excision
Summary
The excision of a neuroma in the digital nerve involves surgically removing a painful bundle of nerve tissue in one or both digital nerves of the same digit. This procedure is typically performed to alleviate pain and improve function in the affected finger or toe.
Purpose
Addresses: Painful neuromas in the digital nerves of fingers or toes
Goals: Relief of pain, restoration of normal function, and prevention of neuroma recurrence
Indications
Symptoms: Persistent pain, tingling, burning sensation, numbness in the toe or finger.
Conditions: Neuromas that do not respond to conservative treatments like orthotics, medication, or physical therapy.
Patient Criteria: Patients with confirmed diagnosis of a digital neuroma unresponsive to non-surgical interventions.
Preparation
Instructions: Fasting for 6-8 hours prior if general anesthesia is used; adjusting or stopping certain medications as advised by the doctor.
Diagnostic Tests: Imaging (e.g., MRI, ultrasound), nerve conduction studies, physical examination
Procedure Description
- The patient is positioned usually in a reclining or supine position.
- Local or general anesthesia is administered to ensure comfort.
- An incision is made over the affected digit where the neuroma is located.
- The neuroma is carefully dissected and removed from the digital nerve.
- The incision is closed with sutures.
- A bandage or dressing is applied to the surgical site.
Tools: Scalpel, forceps, sutures, surgical dressings
Anesthesia Details: Typically local anesthesia, but general anesthesia may be used in certain cases
Duration
The procedure typically takes about 30 minutes to 1 hour, depending on the complexity.
Setting
This procedure can be performed in an outpatient surgical center or a hospital operating room.
Personnel
Surgeons: Orthopedic surgeon or specialized podiatrist
Nurses: Surgical nurses and post-operative care nurses
Anesthesiologists: If general anesthesia is utilized
Risks and Complications
Common Risks: Infection, bleeding, scarring, temporary numbness
Rare Risks: Permanent nerve damage, chronic pain, neuroma recurrence
Management: Antibiotics for infection, pain management strategies, follow-up care
Benefits
Expected Benefits: Relief from chronic pain, improved function and mobility of the affected digit
Realization Time: Benefits may be immediate post-surgery or might take a few weeks as the site heals
Recovery
Post-Procedure Care: Keep the surgical site clean and dry, follow wound care instructions, take prescribed pain medication.
Expected Recovery Time: Typically 2-4 weeks; avoid heavy lifting or strenuous activity
Follow-Up: Regular follow-up appointments to monitor healing
Alternatives
Non-Surgical: Orthotics, physical therapy, medications (e.g., anti-inflammatories, corticosteroid injections)
Pros and Cons: Non-surgical options are less invasive but may not provide permanent relief. Surgery provides more definitive treatment but carries surgical risks.
Patient Experience
During Procedure: Minimal to no sensation if local anesthesia is used; under general anesthesia, the patient will be asleep. After Procedure: Mild to moderate pain managed with medication, some swelling and bruising, temporary restrictions on movement and activity.
Pain management includes prescribed analgesics and comfort measures such as elevation and ice application to reduce swelling.