Targeted muscle reinnervation (TMR) was initially designed to provide cortical control of upper limb prostheses through a series of novel nerve transfers. Early experience has suggested that TMR may also inhibit symptomatic neuroma formation. We present the first report of TMR performed at the time of a traumatic shoulder disarticulation. The procedure was done to prevent painful neuroma pain and allow for myoelecteric prosthetic use in the future. Eight months post-operatively, the patient demonstrates multiple successful nerve transfers and exhibits no evidence of neuroma pain on clinical exam. Using the Patient Reported Outcomes Measurement Information System (PROMIS), the patient demonstrates minimal pain interference or pain behavior. Targeted muscle reinnervation may be considered in the acute trauma setting to prevent neuroma pain and to prepare patients for myoelectric prostheses in the future.
Approximately 34,000 Americans are living with major upper extremity amputations secondary to trauma . Over two thirds of these amputees are adolescents and adults younger than 45 years of age . At the time of surgical revision amputation, major mixed nerves are usually treated with traction neurectomy. This technique may lead to painful neuroma formation as a result of an uncoordinated attempt of the nerve fibers to regenerate. Painful neuromas often prevent consistent prosthetic use, further limiting the functional capacity of the amputee.
Targeted muscle reinnervation (TMR) was initially developed to permit intuitive control of upper limb prostheses by performing a series of novel nerve transfers in established amputees [3–11]. For shoulder disarticulation patients, the goal is to create four independent myoelectric control sites for hand open, hand close, elbow extension, and elbow flexion . Clinical experience has demonstrated TMR to be an excellent treatment for neuroma pain in the amputee. By providing a nerve target for the transected brachial plexus nerve endings, TMR serves to restore continuity of the nervous system despite the absence of native distal nerve segments. As suggested by clinical and preclinical data, reconstitution of nerve integrity through nerve transfer or repair successfully inhibits neuroma formation [5, 7]. These nerve transfers simultaneously provide the potential for appropriate patients to be fit with cortically controlled myoelectric prostheses . TMR performed at the time of initial trauma presentation or during the initial hospitalization has not been reported.
Source: Hand, 9(2), 253-257.
Author: Cheesborough, J. E., Souza, J. M., Dumanian, G. A., & Bueno, R. A., Jr. (2014).https://journals.sagepub.com/doi/10.1007/s11552-014-9602-5