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June 1, 1984

Pain and Enlargement of an Amputated-Leg Stump

Author Affiliations

Mount Sinai School of Medicine Elmhurst, NY

JAMA. 1984;251(21):2793. doi:10.1001/jama.1984.03340450021011

To the Editor.—  I believe the answer by Dr Milton Alter1 of Temple University School of Medicine to the question raised under the above heading requires amplification.The left common iliac artery ligation was performed 39 years ago. None of the nerves passing into the stump run close to this artery. In addition, it is inconceivable that the patient could have been suffering from "nerve irritation" for 39 years without the nerve becoming atrophied or the muscles wasted. I agree that the enlargement of the stump and buttock suggests recurrence or persistence of the arterial venous communications.I advise against any injection of local anesthetic or steroids in this situation for two reasons. First, there really is no good evidence of the effectiveness of this technique in relieving symptoms due to so-called trigger points or stump neuromas. Second, there is considerable risk here of entering an abnormal vascular channel with