New Innovations in Targeted Muscle Reinnervation

Abstract

Targeted muscle reinnervation allows for the creation of additional electromyographic signals for a myoelectrically controlled prosthesis in patients who have undergone an upper-extremity amputation. » Targeted muscle reinnervation shows promise in addressing neuroma pain in both the upper and lower extremities. » Areas of further research include targeted sensory reinnervation as well as use in pediatric patients. » Osseointegration remains a challenge in need of further research given the high risk of infection. Disclosure: There was no source of external funding for this study. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A452).

Targeted muscle reinnervation for the management of pain in the setting of major limb amputation

“… 15 Substantial clinical success was demonstrated with several initial case reports. 16 – 18 Notably, the amplification of myoelectric signals for advanced bioprosthetic limbs in the upper extremity occurs regardless of the timing of TMR, that is, whether it is performed as primary or secondary TMR. 18 In addition to good functional outcomes, it was noted that many patients who underwent TMR had subjective improvement in their pain.…”

“… 16 – 18 Notably, the amplification of myoelectric signals for advanced bioprosthetic limbs in the upper extremity occurs regardless of the timing of TMR, that is, whether it is performed as primary or secondary TMR. 18 In addition to good functional outcomes, it was noted that many patients who underwent TMR had subjective improvement in their pain. 18 This led to studies investigating TMR as a clinical strategy to treat established neuromas of amputated limbs.…”

“… 18 In addition to good functional outcomes, it was noted that many patients who underwent TMR had subjective improvement in their pain. 18 This led to studies investigating TMR as a clinical strategy to treat established neuromas of amputated limbs. TMR in the upper limb is now commonly employed to optimize control of myoelectric prostheses, but is also utilized for prevention or treatment of neuroma pain.…”

“…TMR of the lower extremity is often performed in below knee and above knee amputations and is used to prevent or treat neuroma and PLP. 18 Current mainstream lower extremity prosthetics do not require the myoelectric signals that their upper extremity counterparts do. Thus, performing TMR in the lower extremity, whether it be primary or secondary, is typically aiming to prevent and treat neuroma formation and pain only.…”

Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

“…Even when amputation is necessary, the new approach with targeted muscle reinnervation have shown encouraging results in treating neuroma and phantom limb pain. Moreover, technologic developments in robotics and signal processing, as well as advancements in neuroplasticity research keep expanding targeted muscle reinnervation applications in prosthesis control [106] . Older studies reported complex Gustilo type IIIC injuries result in very high amputation rates, together with high and unjustified costs for the healthcare system and the patients [107][108][109] .…”