A Needle Over the Knife: Rapid Relief with Micro-volume Phenol Neurolysis in a Painful Digital Neuroma

Abstract Painful digital neuromas are an uncommon but debilitating cause of chronic neuropathic hand pain. Symptoms often persist despite conservative management, and surgical revision is associated with variable outcomes and a significant risk of recurrence. Minimally invasive, nerve-targeted interventions may offer effective pain relief while avoiding additional surgical morbidity. Reporting successful alternative approaches is important to inform clinical decision-making in selected refractory cases. We report the case of a 49-year-old Indian woman with severe, refractory neuropathic pain of the right index finger following prior surgery for a presumed glomus tumour. Clinical features and high-resolution ultrasonography confirmed a symptomatic digital neuroma. Given persistent symptoms and the unpredictable outcomes of repeat surgery, landmark-guided micro-volume phenol neurolysis was performed using a 26-gauge needle and 0.2 mL of 6% phenol. The patient experienced rapid and marked pain relief, with sustained functional improvement and no complications. This case demonstrates that micro-volume phenol neurolysis may offer a minimally invasive option for pain relief in carefully selected patients with painful digital neuromas. As a low-morbidity technique, it may represent a valuable therapeutic option when conservative measures fail, and surgical revision is undesirable. However, larger studies are required to establish its effectiveness, define appropriate patient selection and determine long-term outcomes.