Targeted Muscle Reinnervation

What is targeted muscle reinnervation?

Those who experience phantom limb pain, residual limb pain or peripheral neuropathy may have less pain and better-functioning limbs through a procedure that reroutes nerves in the body.

Burning, often debilitating pain can come from neuromas, a combination of nerve scar tissue and sprouts of regenerated nerves. The sprouts of regenerated nerves are disorganized, continuing to send signals when the signals have nowhere to go.

TMR can reroute damaged nerves or nerves cut during amputation into motor nerves in nearby muscle, re-establishing neural circuitry and giving the nerves somewhere to go and something to do. This decreases painful neuroma formation and reduces phantom limb pain.

TMR originally was developed to allow those with upper-limb amputations to have better control of their limb prosthetics. When nerves are rerouted to specific nerves in specific muscles, it allows for more individual muscle function, providing for more refined movements and a wider range of motion with an advanced prosthetic.

Surgeons at The Ohio State University Wexner Medical Center perform more primary TMR procedures than any other medical center in the world, and we have pioneered the TMR technique for pain relief in amputees.

The Ohio State Wexner Medical Center researchers have found that TMR is also a reliable way to treat and prevent those painful, disorganized nerves, or symptomatic neuromas, from developing at all. And when performed even years after an amputation or other nerve damage, TMR is an effective method for reducing phantom limb pain, residual limb pain or peripheral neuropathy and improving patients’ quality of life.

TMR poses minimal health risks for patients, and recovery is similar to that of traditional amputation surgery.

Who is a candidate for TMR surgery?

Amputees or those who will have an amputation are candidates for TMR surgery.

Primary or Acute TMR

Primary TMR (or acute TMR) is performed at the time of initial amputation.

Secondary or Delayed TMR

In secondary TMR, or delayed TMR, patients who have had a previous amputation are seen and evaluated in the Ohio State Wexner Medical Center’s Department of Plastic Surgery clinic. Surgery is elective and subject to preoperative medical clearance. Candidates for this surgery include those amputees who suffer from:

• Painful neuroma(s) 
• Phantom limb pain 
• Residual limb pain causing issues wearing prosthetics or affecting activities of daily living

Those with damaged nerves or painful nerves

The Ohio State Wexner Medical Center's surgeons are able to treat peripheral nerve issues and neuromas unrelated to amputation with procedures similar to TMR, rerouting nerves to reduce pain. 

What to expect during targeted muscle reinnervation surgery?

Preparing for your procedure

Before scheduling your TMR procedure, you’ll meet with a surgeon for a consultation to discuss your individual situation and how TMR may benefit you. At this appointment, you’ll need to bring with you your medical records, including any imaging and operative reports. You may also send these records to our office ahead of time. 

At this consultation, the surgeon may perform a local nerve block in the office to help determine, based on your body’s reaction, whether you would be a good candidate for TMR. 

Depending on the type of surgery you need, your TMR procedure may be scheduled between about two weeks and three months after your first consultation. 

During your procedure

TMR surgery typically takes between two and four hours and often requires a one- to five-day hospital stay, depending on the extent of your operation and the post-surgery pain management you need. 

After your procedure

Primary TMR

Those who have a new amputation and receive primary TMR should expect postsurgery follow-up appointments scheduled at the two-week, four-week, three-month, six-month and 12-month marks, with annual follow-ups. If needed, discussions about your prosthetic typically begin between two and four weeks after amputation surgery. About four to six weeks after surgery, the prosthetic-fitting process may begin, along with stump-molding and fabrication of a trial prosthesis. Commonly you will receive a prosthesis between six and eight weeks after surgery. 

Recovery time from amputation and primary TMR varies from person to person, as some amputations present dramatic life changes. 

Secondary TMR

Amputees who typically use a prosthetic should expect to abstain from using it for six weeks while healing after surgery. Follow-up appointments commonly are scheduled at the two-week, four-week, three-month, six-month and 12-month marks after surgery, with annual follow-ups. Secondary TMR patients typically can expect to be able to work again as soon as two weeks after surgery, depending on the type of work. 

Procedures to treat painful nerve issues

Follow-up appointments will be scheduled based on your individual needs. Depending on their work, patients with these procedures typically can expect to be able to work again as soon as two weeks after surgery. 

Why choose Ohio State for targeted muscle reinnervation?

The Ohio State University Wexner Medical Center is home to TMR experts who are leading the way both in performing the procedure and in developing research surrounding its use. 

The Ohio State Wexner Medical Center TMR team includes plastic and reconstructive surgeons, orthopedic surgeons, physical therapists, physician assistants and nurses who specialize in the procedure and are part of a uniquely multidisciplinary network of care providers developing individualized treatment plans for patients. 

At the Ohio State Wexner Medical Center, primary TMR is the standard of care for most types of traumatic and oncologic amputations.