Targeted Muscle Reinnervation in the Hand: Treatment and Prevention of Pain After Ray Amputation

J Hand Surg Am. 2020 Sep;45(9):884.e1-884.e6. doi: 10.1016/j.jhsa.2019.10.020. Epub 2019 Dec 6.


Targeted muscle reinnervation (TMR), originally developed as an experimental technique for prosthetic control, has been shown to be safe and effective for the treatment and prevention of postamputation pain. Targeted muscle reinnervation involves coaptation of residual nerve ends to nearby motor nerve branches of healthy but expendable muscles proximal to an amputation. It has been shown to prevent and reduce residual limb pain and phantom limb pain after major upper and lower extremity amputation. However, the use of this technique has not been described distal to the forearm because bioprosthetic use is not a consideration at that level. The aim of this article was to (1) present 2 cases of TMR performed in the setting of ray amputation, and (2) provide technical strategies for maximizing success and efficiency.

Keywords: Digital neuroma; nerve transfers; postamputation pain; ray amputation; targeted muscle reinnervation.

Publication types

  • Case Reports

MeSH terms

  • Amputation Stumps
  • Amputation, Surgical
  • Humans
  • Muscle, Skeletal
  • Nerve Transfer*
  • Neuroma* / surgery
  • Phantom Limb* / surgery