After upper-limb amputation, a surviving nerve can still carry a useful command. TMR gives that signal a new muscle target.

In this episode of Plastics in Practice, we review how targeted muscle reinnervation supports prosthetic control and helps address nerve-related postamputation pain.

Key takeaways:

• Define the goal before choosing transfers: nerve-related pain, prosthetic control, or both.

• TMR connects a residual nerve to a motor branch supplying viable, functionally expendable muscle.

• For motor control, the reinnervated muscle amplifies an intended movement into a signal that surface electrodes can detect.

• Preserve useful native muscle and existing control sites when planning new targets.

• Neuroma-related residual-limb pain and phantom limb pain can coexist and need separate assessment.

• TMR can help reduce nerve-related postamputation pain, but relief is not guaranteed. Pain-directed surgery need not depend on prosthesis use.

• Coordinate surgery, socket fitting and rehabilitation. Better motor signals do not automatically restore sensation.

This content is for educational purposes only and is not medical advice.

The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience.

Editorial clarification at approximately 13:55: The French prospective series compared preemptive TMR with conventional treatment at primary amputation (neuroma burial or simple neurectomy), not with delayed TMR. Mathieu et al., 2025, PMID 39853391: https://pubmed.ncbi.nlm.nih.gov/39853391/

YouTube Short: https://youtube.com/shorts/Vc_3CT2Ysc0

Full video explainer: https://www.youtube.com/watch?v=sUN2KmZDnzA

Instagram account: https://www.instagram.com/plasticsinpractice/

Free study guide: https://drive.google.com/file/d/1_W0mGn-QoVqSUIUXyICkmqJsJwSKzaX1/view

#TargetedMuscleReinnervation #PeripheralNerveSurgery #UpperLimbAmputation #ProstheticRehabilitation #PlasticSurgeryEducation

References:

1. Eberlin et al. A Consensus Approach for Targeted Muscle Reinnervation in Amputees. 2023. https://pmc.ncbi.nlm.nih.gov/articles/PMC10079335/

2. Dumanian et al. Targeted Muscle Reinnervation Treats Neuroma and Phantom Pain in Major Limb Amputees: A Randomized Clinical Trial. 2019. https://pubmed.ncbi.nlm.nih.gov/30371518/

3. Stubblefield et al. Occupational therapy protocol for amputees with targeted muscle reinnervation. 2009. https://pmc.ncbi.nlm.nih.gov/articles/PMC3031096/