Disclosures: Benjamin Miller, DO: Nothing to disclose

Case Description: A 65-year-old woman with a prior history of left breast cancer status post left lumpectomy and sentinel lymph node biopsy with adjuvant radiation who presents complaining of recurrent left chest wall pain that radiates into her left breast. She had previously been treated by her oncologist and pain management physician with narcotics, epidural steroid injections, and steroid dose packs without successful resolution of her pain. She also trialed physical therapy for stretching and strengthening, which initially helped but did not provide lasting relief.

Setting: Cancer rehabilitation outpatient clinic.

Patient: A 65-year-old woman with a history of breast cancer s/p lumpectomy with left chest wall pain.

Assessment/Results: Her physical exam was remarkable for chest wall point tenderness 4 inches distal to the axilla in an intercostal space. Due to this exam, a neuroma was suspected, and given previously failed alternative treatments, this region of localized pain was targeted. Anesthetic and corticosteroid was injected into the location of suspected neuroma and chest wall pain under ultrasound guidance, resulting in resolution of her pain.

Discussion: The differential diagnosis of postmastectomy pain syndrome is broad and encompasses multiple systems. After ruling out more common musculoskeletal and radiation induced injuries, it is important to consider less common causes including neuroma formation, which can occur at post-surgical sites and are often provoke by palpation. Localized injections can be an effective means of treating these symptoms related to neuromas in the post-mastectomy patient.

Conclusion: Postmastectomy pain syndrome is a leading cause of reduced quality of life and morbidity in patients after mastectomy, lumpectomy, breast augmentation, and reduction. Neuroma formation is one potential cause which clinicians should consider. A proper diagnosis is key to effective treatment, which can be accomplished with minimally invasive techniques in appropriate patients.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/resolution-of-lateral-chest-wall-postmastectomy-neuroma-pain-after-interventional-treatment-a-case-report/