Benign Extraneural Soft-Tissue Tumors of the Extremities Causing Compression of Nerves

Thirty-two patients with benign soft-tissue tumors of the extremities, causing nerve compression, exclusive of neurogenic tumors, have been seen at the Mayo Clinic. The peak incidence of these lesions was in the fifth decade, and the most frequent symptoms and signs were progressive weakness of parts of an extremity and a palpable mass. The average period between the onset of symptoms and treatment in this group was 13.6 months. Trauma was probably of significance in two cases of occult bursal enlargement at the elbow. The ulnar nerve was the nerve most commonly involved in the group. Roentgenographic examination revealed the radiolucent soft-tissue mass characteristic of a lipoma in ten patients. Lipomata accounted for approximately half of the tumors in our series. In ten patients, the extraneural tumor was not demonstrable prior to surgical exploration. Treatment should consist in initial complete excision of the lesion with the double-tourniquet technique, with appropriate draping of the entire limb to allow for extra exposure of the nerve, if segmental resection and suture are necessary. A general anesthetic should be used, and the exploration should be performed by a team familiar with soft-tissue or neurogenic tumors. Neurolysis or translocation of the ulnar nerve may be required as well as simple excision of the tumor. Almost complete return of function should he achieved eventually provided that irreversible damage to the involved nerve has not been produced before operation. In the fourteen patients previously mentioned who noticed almost complete or complete return of function, the average duration for this return was three years with the extremes being three months and fourteen years.