What is Targeted Muscle Reinnervation? | Treating Phantom Limb Pain

Targeted Muscle Reinnervation Surgery for Phantom Limb Pain

Chronic pain impacts more than two million amputees in the United States. If you are among them, you may be experiencing phantom limb pain, chronic pain in your stump, or pain within a nerve cluster or neuroma.

Phantom limb pain is a complex pain syndrome described as burning, aching, or electric-type pain in the amputated limb. This pain often begins shortly after surgery. In some cases, phantom limb pain may gradually go away over time. However, for many patients, phantom limb pain becomes a chronic and debilitating condition.

Inadequate control of preoperative and postoperative pain may increase the risk of chronic amputation pain. This highlights the importance of comprehensive pain management strategies both before and after amputation surgery.

Residual limb pain, also known as stump pain, is another common issue faced by amputees. This pain occurs in the remaining part of the limb and can be caused by various factors, including poor prosthetic fit, skin irritation, or the development of neuromas. Neuromas are disorganized growths of nerve tissue that form when severed nerves attempt to reconnect, often resulting in painful nerve clusters.

At Center for Hand and Upper Extremity Surgery, our world-renowned physicians have developed their skills around a proven procedure to treat, reduce, and ultimately eliminate chronic pain for amputees: Targeted Muscle Reinnervation or TMR Surgery. This innovative technique involves redirecting severed nerves into nearby muscles, providing them with a new purpose and potentially reducing pain.

TMR has shown promising results in addressing both neuroma pain and phantom limb pain. By giving the severed nerves a new target, it can prevent the formation of painful neuromas and may help reorganize the way the brain processes signals from the amputated limb.

Our team of experts is dedicated to providing comprehensive care for amputees, combining surgical expertise with advanced pain management techniques. Through TMR and personalized strategies, we strive to help our patients regain comfort, function, and quality of life.

Our
Approach

icon-3-blue (1)

Understanding Neuromas

A neuroma is a disorganized growth of nerve cells at the site of a nerve injury. A neuroma occurs after a nerve is partially or completely disrupted by an injury — either due to a cut, a crush, or an excessive stretch. During limb amputation, the nerves are cut and one end is removed with the limb, preventing the nerve from repairing itself.
lp-icon-1-blue (1)

Identifying Symptoms

Neuromas can be painful and can cause tingling sensations when tapped or when pressure is applied. Although not always the case, a neuroma can be extremely painful and can cause significant loss of function for the patient by limiting motion and contact with the affected area. This can also make wearing a prosthesis impossible.
wc-icon1-blue (1)

Treating Phantom Limb Pain

Treatment of phantom limb pain is approached in a manner similar to treatment of other conditions that result in chronic neuropathic pain. Advanced nerve surgery techniques can be used to provide long-term pain relief where non-invasive therapies have failed or ceased to be effective.

We Treat Phantom Limb Pain
at 29 Locations Across New Jersey, New York, and Pennsylvania

Red Bank
Red Bank
address-icon
331 Newman Springs Rd. 
Building 2 - First Floor, STE 200
Red Bank, New Jersey 07701
phone-icon
Phone: 855-980-6981
East Brunswick
East Brunswick
address-icon
192 Summer Hill Rd
Suite 201
East Brunswick, New Jersey 08816
phone-icon
Phone: 855-980-6981
Hopewell
Hopewell
address-icon
1 Capital Way
Suite 390
Pennington, New Jersey 08534
phone-icon
Phone: 855-980-6981
Rockland County
Rockland County
address-icon
257 Lafayette Ave
Suite 200
Suffern, New York 10901
phone-icon
Phone: 201-967-9200

About
The Institute for
Advanced Reconstruction

The Center for Hand and Upper Extremity Surgery is uniquely positioned as the ‘go-to’ center for revolutionary hand and upper extremity procedures, as well as world-class reconstructive treatments.

These include cutting-edge procedures such as nerve transplantation that may restore a significant degree of function for those who have suffered from stroke and other forms of paralysis. Patients who at one time believed they had exhausted their paralysis treatment options come from around the country and the globe to our practice in New York City and Red Bank, New Jersey.

Frequently
Asked
Questions

What happens to nerves after amputation?
When a limb is amputated, one end of the nerves connecting that limb to the brain and central nervous system will be severed as well. In this process, damaged nerve fibers may metastasize into a mass which we call a Neuroma. This mass will send confused signals to the brain and can cause mild to extreme pain.
How common is phantom limb pain?

Phantom limb pain is quite common, affecting 60-85% of all amputees. Most patients who suffer from phantom limb pain will experience relief through treatments that mirror other neuropathic pain treatments: rehabilitation and, ultimately, surgery.

What is Targeted Muscle Reinnervation (TMR)?

Targeted Muscle Reinnervation (TMR) surgery involves the transfer of nerves that once controlled the amputated limb to reinnervate (restore function to) remaining muscles. Following surgery, nerves grow back into the new muscles, decreasing and potentially preventing misdirected nerve growth, which can contribute to pain within the residual limb. TMR has the potential to treat pain from neuromas while enabling amputee patients to return to their activities of daily living and improve prosthetic use and tolerance.

What does a TMR surgery include?

Targeted Muscle Reinnervation (TMR) surgery requires a graft of nerves from one area of the body to reinstate healthy (and less painful) nerve function inside the limb remains, partial limb, stump, or other connective tissue.

How effective is TMR surgery?
Patients who experience chronic nerve pain often exhaust all other options before choosing surgery. However, once surgery is “on the table” as an option for patients, we answer every question and ensure complete confidence before we begin this course of treatment.
back-to-top