Targeted Muscle Reinnervation
Definition
Targeted muscle reinnervation, or TMR, is a surgical procedure that helps reduce nerve pain after limb amputation and improve prosthetic control. During targeted muscle reinnervation surgery, surgeons connect severed nerves from an amputated limb to nearby muscles that no longer have an important function.
The procedure helps give nerve signals a new pathway. This may reduce phantom limb pain, residual limb pain and other forms of chronic nerve pain that can develop after limb loss.
Alternative names
Nerve transfer procedure; Nerve transfer surgery for amputees; Targeted muscle reinnervation surgery; Targeted reinnervation; TMR; TMR surgery
Treatment
Targeted muscle reinnervation is one treatment option for managing nerve injury and pain after limb loss. Related treatments may include:
- Medications for neuropathic pain
- Neuroma surgery
- Occupational therapy
- Pain management programs
- Physical therapy
- Prosthetic training
- Psychological support for adjusting to limb loss
- Regenerative peripheral nerve interface, or RPNI, procedures
- Traction neurectomy
Nonsurgical alternatives may help manage symptoms, although they do not reroute damaged nerves. These treatments may include:
- Behavioral health counseling
- Desensitization techniques
- Mirror therapy
- Nerve pain management programs
- Pain medications
- Physical therapy
- Prosthetic rehabilitation
While these approaches may reduce pain, they generally do not address the underlying severed nerve the way targeted muscle reinnervation does.
Before the procedure
Before targeted muscle reinnervation surgery, patients meet with their surgical team to discuss treatment goals and expected outcomes.
The evaluation may include:
- A physical examination
- Assessment of residual limb pain and phantom limb pain
- Evaluation of current prosthetic use
- Imaging studies when needed
- Review of medical history
- Review of medications
Patients may also meet with rehabilitation specialists and prosthetists to develop a treatment plan. Before surgery, patients may be asked to:
- Arrange transportation home
- Discuss current medications with their healthcare team
- Follow instructions about eating and drinking
- Stop smoking
After the procedure
Recovery varies depending on the type of amputation, the nerves involved and the patient’s overall health. After surgery, patients may experience:
Rehabilitation is an important part of recovery. Patients often work with physical therapists and prosthetic specialists to improve strength, mobility and prosthetic control.
Nerve healing occurs slowly. Improvements in pain and function may continue for months after surgery as reinnervation develops.
Many patients report reduced phantom pain and better use of prosthetic devices as healing progresses.
Potential side effects
Possible side effects and complications include:
- Bleeding
- Continued phantom limb pain
- Delayed wound healing
- Failure to achieve the desired level of pain relief
- Infection
- Injury to nearby nerves
- Pain at the surgical site
- Persistent nerve pain
- Scarring
- Swelling
- Temporary numbness
Although complications are uncommon, patients should discuss potential risks with their plastic surgeon before treatment.
Outlook
The outlook for many amputees who undergo targeted muscle reinnervation is encouraging. Studies have shown that TMR can help reduce phantom limb pain, residual limb pain and other forms of chronic pain associated with limb amputation.
Not every patient experiences the same results, and some may continue to have pain or require additional treatment. However, targeted muscle reinnervation has become an important option for managing postamputation pain and improving function after limb loss.
Ongoing rehabilitation, proper prosthetic fitting and regular follow-up care can help support the best possible outcomes after targeted muscle reinnervation surgery.
This entry was written by Jennifer Cruz-Urbano, marketing specialist, and reviewed for accuracy by Bruce Mast, MD, FACS. Generative AI was leveraged as part of the content creation process.