C-section Leaves Woman With Chronic Intractable Pain Syndrome

This case involves a woman who developed neuroma formations at the site of a previous cesarean section scar. The patient complained of intractable pain after surgery and her doctors recommended a resection procedure to relieve the pain. The surgeon identified an iliofemoral neuroma but chose not to resect the mass. Instead, he decided to bury it beneath the scar tissue. The patient now suffers from increased pain that was recently diagnosed by a pain management specialist as complex regional pain syndrome.

Question(s) For Expert Witness

1. What is the standard of care in making a timely diagnosis to prevent the long-term effects of the pain syndrome?

Expert Witness Response E-000699

For some time, the literature has described neuromas sonographically as ovoid, hypoechoic masses. Ultrasound also provides guidance during corticosteroid injections as a means to alleviate pain. In addition, it has been reported to be helpful in the detection and treatment of painful stump neuromas from amputations. Frequently, this condition is missed in patients who often have their complaints dismissed as psychosomatic. It is now common belief that ultrasound can provide valuable assistance in identifying the neuroma, defining its exact location, and improving the success rate of neuroma injections. This should improve the long-term prognosis. Also, ultrasound scanning should be considered as a diagnostic and therapeutic modality when a neuroma is suspected.