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Targeted Muscle Reinnervation: A Novel Approach to Postamputation Neuroma Pain

  • Symposium: Recent Advancements in amputation surgery and rehabilitation
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Postamputation neuroma pain can prevent comfortable prosthesis wear in patients with limb amputations, and currently available treatments are not consistently effective. Targeted muscle reinnervation (TMR) is a decade-old technique that employs a series of novel nerve transfers to permit intuitive control of upper-limb prostheses. Clinical experience suggests that it may also serve as an effective therapy for postamputation neuroma pain; however, this has not been explicitly studied.

Questions/purposes

We evaluated the effect of TMR on residual limb neuroma pain in upper-extremity amputees.

Methods

We conducted a retrospective medical record review of all 28 patients treated with TMR from 2002 to 2012 at Northwestern Memorial Hospital/Rehabilitation Institute of Chicago (Chicago, IL, USA) and San Antonio Military Medical Center (San Antonio, TX, USA). Twenty-six of 28 patients had sufficient (> 6 months) followup for study inclusion. The amputation levels were shoulder disarticulation (10 patients) and transhumeral (16 patients). All patients underwent TMR for the primary purpose of improved myoelectric control. Of the 26 patients included in the study, 15 patients had evidence of postamputation neuroma pain before undergoing TMR.

Results

Of the 15 patients presenting with neuroma pain before TMR, 14 experienced complete resolution of pain in the transferred nerves, and the remaining patient’s pain improved (though did not resolve). None of the patients who presented without evidence of postamputation neuroma pain developed neuroma pain after the TMR procedure. All 26 patients were fitted with a prosthesis, and 23 of the 26 patients were able to operate a TMR-controlled prosthesis.

Conclusions

None of the 26 patients who underwent TMR demonstrated evidence of new neuroma pain after the procedure, and all but one of the 15 patients who presented with preoperative neuroma pain experienced complete relief of pain in the distribution of the transferred nerves. TMR offers a novel and potentially more effective therapy for the management of neuroma pain after limb amputation.

Level of Evidence

Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Aaron Barrow MD his assistance with data collection. We also thank Christopher Wilson MD and Robert Granville MD for sharing the results of their upper-limb TMR procedures.

Author information

Authors and Affiliations

  1. Division of Plastic Surgery, Northwestern Feinberg School of Medicine and Neural Engineering Center for Artificial Limbs, 675 N St Clair, Suite 19-250, Chicago, IL, 60610, USA

    Jason M. Souza MD, Jennifer E. Cheesborough MD & Gregory A. Dumanian MD

  2. Division of Plastic Surgery, Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA

    Jason H. Ko MD

  3. Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, San Antonio, TX, USA

    Mickey S. Cho MD

  4. Center for Bionic Medicine, Rehabilitation Institute of Chicago, Chicago, IL, USA

    Todd A. Kuiken MD, PhD

Authors
  1. Jason M. Souza MD
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  2. Jennifer E. Cheesborough MD
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  3. Jason H. Ko MD
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  4. Mickey S. Cho MD
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  5. Todd A. Kuiken MD, PhD
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  6. Gregory A. Dumanian MD
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Corresponding author

Correspondence to Gregory A. Dumanian MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

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Souza, J.M., Cheesborough, J.E., Ko, J.H. et al. Targeted Muscle Reinnervation: A Novel Approach to Postamputation Neuroma Pain. Clin Orthop Relat Res 472, 2984–2990 (2014). https://doi.org/10.1007/s11999-014-3528-7

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  • DOI: https://doi.org/10.1007/s11999-014-3528-7

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