Targeted Muscle Reinnervation

Targeted muscle reinnervation (TMR) is an advanced surgical procedure that involves transferring the nerves that once controlled an amputated arm or hand to reinnervate (restore function to) the remaining muscles. Following surgery, the nerves grow back into the new muscles, allowing for improved control of prosthetic devices. This procedure also prevents misdirected nerve growth or “neuroma” formation, which can contribute to pain within the residual limb or cause “phantom limb syndrome”. 

Conditions Treated

  • Brachial plexus injuries
  • Limb loss
  • Nerve injuries
  • Nerve lacerations
Procedure Time
Single Limb: 3-6 Hours Bilateral: 6-12 Hours
Treatment Location
In-Clinic / Our Surgery Center (outpatient) / Hospital (in-patient)
General Anesthesia
Recovery Time
3 to 6+ Months

Benefits of Targeted Muscle Reinnervation Surgery

Targeted muscle reinnervation allows patients to achieve a new level of function with prosthetic devices and an improved quality of life. While the journey to recovery can be long and demanding, patients are often able to resume many of their pre-amputation activities. For those undergoing immediate TMR, the risk of phantom limb pain or stump pain is significantly decreased. In delayed TMR cases, many patients experience relief of chronic pain.

  • Regain basic limb mobility and control
  • Reanimate muscles to enhance prosthetic use and control
  • Reduce limb pain through redirected nerve signals
  • Prevent problematic muscle contraction and spasms
  • Improve ability to perform daily tasks and self-care
  • Prepare for advanced prosthetic fitting and use
  • Reduce phantom limb pain sensations


Are you a candidate?

Patients who have undergone an amputation without TMR may be candidates for a delayed TMR procedure if they are experiencing difficulties with prosthetic control and/or tolerance. Delayed TMR procedures may also be performed to alleviate chronic pain following an amputation, such as phantom limb pain or stump pain.

Find Your Surgeon

The surgeons at the Center for Hand and Upper Extremity Surgery have advanced training in both complex nerve reconstruction as well as innovative musculoskeletal procedures. Their combined expertise in microsurgical nerve transfer techniques and targeted soft tissue reconstruction allows them to surgically reroute nerves and reanimate muscles in ways that restore maximal function after limb loss and major nerve injuries.

What To Expect


Targeted muscle reinnervation may be performed at the time of an amputation (immediate TMR) or after an amputation (delayed TMR). An immediate TMR procedure has the ability to provide patients with improved prosthetic control and a quicker return to everyday life following an amputation. 


The surgeon will make incisions around your residual limb at the amputation site and locate the major nerves that previously controlled your amputated limb. Next, the surgeon will cut those nerves and then stitch the ends into nearby nerves that control functionally redundant muscles or small pockets of muscle tissue in your residual limb. 


Patients typically need to stay in the hospital for 1-3 nights after a TMR procedure prior to discharge home. The hospital stay allows us to closely monitor for bleeding, circulation, and nerve function in the immediate postoperative period. Frequent neurological checks will be done, and the affected limb will be immobilized and protected. Pain and discomfort are common, and medication will be given to manage post-surgical discomfort.



Following surgery, the nerve endings will regenerate and grow into the muscle over a period of months. You may experience some numbness, tingling, or twitching as the nerves regrow. You may begin physical therapy as early as 2-4 weeks after surgery to train your brain to control the reinnervated muscles. After 1-2 months, physical therapy progresses to heavy strengthening and myoelectric prosthetic training may start (if applicable). With practice, you will be able to contract specific muscle areas to send signals that control the movements of your prosthetic hand or joint. 

Real people. Real results.

Meet Lydia,

who underwent TMR (targeted muscle reinnervation) surgery on her dominant hand to help her adapt to using a prosthesis.

Lydia Gray suffered a severe traumatic injury to her left hand that resulted in amputation. After undergoing TMR surgery with Dr. Ajul Shah, she has made remarkable progress using a prosthetic hand, allowing her to stick with her favorite hobbies. 

Patient Resources

Visit our Patient Resource Center online to access useful information such as intake forms, tips for your first appointment, ways to prepare for surgery, and more.


What are the risks of TMR surgery?

While TMR can allow for improved prosthetic function, there are some risks and potential side effects to consider:

  • Surgical risks: As with any major surgery, TMR has risks of bleeding, infection, and reaction to anesthesia. Proper surgical techniques help minimize these risks.
  • Nerve damage: The nerves are intentionally cut and reattached during TMR, which can cause nerve pain or numbness. This usually resolves over time as the nerves regenerate.
  • Muscle atrophy: The denervated muscles that are reinnervated may atrophy or shrink over time if the new nerve connections are not robust. Physical therapy helps strengthen the muscles.
  • Functional limitations: TMR provides improvements but not full restoration of prior limb function. Patients require rehabilitation to maximize new prosthetic control.
Are there any side effects with TMR surgery?
Some patients experience occasional twitches, spasms, or odd sensations in the reinnervated area. These side effects are usually not debilitating.
What rehabilitation is involved after TMR surgery?
Intensive occupational and physical therapy for multiple months. This includes neuromuscular re-education, desensitization, strength training, range of motion, and prosthetic training.
How long until I see results from the procedure?
Early results can be seen at 3-6 months but maximal benefit occurs closer to 12+ months. Improvements continue for 24+ months.
Does TMR help with prosthetic control?
Yes, reinnervated muscles allow intuitive prosthetic control. External electrodes can be implanted to enhance prosthetic function.
HUES Surgeons

Regain Mobility and Independence with Intuitive Prosthetic Control