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Targeted Muscle Reinnervation and Its Role in Acute Management of Above Elbow Amputations

March 01, 2017

Contributors: John White Bracey, MD; Raymond Glenn Gaston, MD; Bryan J. Loeffler, MD; Mark Adam Tait, MD; Mark Adam Tait, MD

2017 AWARD WINNER Targeted muscle reinnervation (TMR) is a surgical technique that may provide patients with intuitive myoelectric prosthetic control and prevent or relieve neuroma-associated pain. This technique involves nerve transfers that increase the number of available electromyographic surface targets, leading to improved patient control of a myoelectric prosthesis. In addition, electromyographic pattern recognition has evolved in conjunction with TMR to further improve prosthetic control. Early case studies indicate that TMR successfully prevents early neuroma formation after amputation and is a highly effective surgical treatment for the management of painful neuromas. TMR has been well described in above-elbow amputees. Advances in surgical and prosthetic technique have led to the use of TMR during the initial hospitalization of all patients at our facility with a transhumeral amputation. This video discusses technical aspects of TMR in above-elbow amputees and the importance of a care team that includes physicians, physical therapists, and prosthetic designers. Thiis video discusses the case presentation of two patients who underwent TMR after traumatic transhumeral amputation. Both patients underwent surgical treatment shortly after initial injury. In both patients, muscle reinnervation occurred, leading to reliable electromyographic signals for control of a myoelectric prosthesis. The intuitive nature of TMR led to early control of the prosthesis. Both patients were able to control a recognition–based myoelectric prosthesis with reinnervated muscles, and neither patient has experienced painful neuroma formation.