Nerve Tumours in the Upper Limb

Tumours are abnormal growths that can develop within a nerve or next to it. These growths can disrupt nerve function in two ways:

  • Benign tumours (non-cancerous) compress the nerve, leading to progressive damage
  • Malignant tumours (cancerous) may invade or destroy the nerve tissue

Both types can cause symptoms such as pain, numbness, weakness, or even muscle wasting, depending on the location and severity.

Tumours are abnormal growths that can develop within a nerve or next to it. These growths can disrupt nerve function in two ways:

  • Benign tumours (non-cancerous) compress the nerve, leading to progressive damage
  • Malignant tumours (cancerous) may invade or destroy the nerve tissue

Both types can cause symptoms such as pain, numbness, weakness, or even muscle wasting, depending on the location and severity.

Types of Nerve Tumours

Nerve tumours arise from cells within or around the nerve. Identifying the tumour type is essential as it determines treatment and outcomes.

Most upper limb nerve tumours are benign and slow growing, but imaging is needed to rule out aggressive forms.

Benign Nerve Tumours

  • Peripheral nerve sheath tumours – these are either Schwannomas or Neurofibromas
  • Schwannomas – arise from Schwann cells that insulate nerves; usually encapsulated and easier to remove without damaging the nerve
  • Neurofibromas – may occur as single tumours or multiple tumours in patients with neurofibromatosis (NF1/NF2)

Malignant Tumours

  • Malignant Peripheral Nerve Sheath Tumours (MPNSTs) – these are rare but aggressive cancers that require urgent multidisciplinary management involving oncologists, surgeons, and radiation specialists.

Benign Nerve Tumours

  • Peripheral nerve sheath tumours – these are either Schwannomas or Neurofibromas
  • Schwannomas – arise from Schwann cells that insulate nerves; usually encapsulated and easier to remove without damaging the nerve
  • Neurofibromas – may occur as single tumours or multiple tumours in patients with neurofibromatosis (NF1/NF2)

Malignant Tumours

  • Malignant Peripheral Nerve Sheath Tumours (MPNSTs) – these are rare but aggressive cancers that require urgent multidisciplinary management involving oncologists, surgeons, and radiation specialists.
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Recognising the Symptoms

You should seek specialist assessment if you experience:

  • A lump or swelling that can be felt under the skin, often along the course of a nerve
  • Sharp, shooting, or burning pain that radiates down the arm or into specific fingers
  • Tinel’s sign – a tingling or electric shock sensation when the lump is tapped
  • Progressive numbness or altered sensation in a specific distribution
  • Weakness in gripping, pinching, or performing fine motor tasks
  • Muscle wasting in the hand or forearm
  • Symptoms that worsen over time or interfere with daily activities

Not all nerve tumours cause symptoms initially. Some are discovered incidentally during imaging or examination for unrelated conditions.

When is Surgery Required?

Surgical removal is typically recommended to prevent progressive deterioration of nerve function. Early intervention can relieve symptoms and preserve nerve function. Most benign nerve tumours can be safely removed without damaging the nerve itself.

However, in approximately 10% of cases, part of the healthy nerve may be firmly attached to the tumour and must be removed along with it. In such cases:

  • A nerve graft is used to reconnect the ends
  • Some loss of nerve function may occur, depending on the nerve involved
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Prognosis and Recovery After Surgical Tumour Removal

Recovery depends on several factors:

  • Patient age – younger patients typically experience better nerve regeneration
  • Tumour size and location – smaller tumours detected early have better outcomes
  • Type of nerve involved – sensory nerves may recover differently than motor nerves
  • Nerve regeneration rate – approximately 1mm per day from the surgical site

Recurrence rates vary by tumour type:

  • Schwannomas: very low recurrence after complete removal
  • Neurofibromas: slightly higher recurrence risk, especially in NF1 patients
  • Regular follow-up imaging is recommended to monitor for recurrence

When to Seek Help

You should contact your surgical team if you experience:

  • A lump in your upper limb that is growing or changing
  • Progressive pain, numbness, or weakness
  • Symptoms that significantly interfere with daily activities or work
  • Rapid onset of symptoms suggesting possible malignancy
  • Concerns about a previously removed tumour potentially recurring

If you have been diagnosed with neurofibromatosis, regular surveillance is recommended even in the absence of symptoms.

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