Upper Extremity Targeted Muscle Reinnervation

Abstract

Residual limb and phantom limb pain can affect as many as 80% of individuals after amputation and can drastically affect a patient's quality of life and ability to wear a prosthetic device. Targeted muscle reinnervation (TMR) is a novel nerve transfer technique developed to increase the number of available electromyography (EMG) signals available for myoelectric prosthetic control. This initial indication has been expanded as later studies have also shown a reduction in opioid usage and increased prosthetic wear, even in highly comorbid patients, secondary to reduced phantom and residual limb pain. In this article we review the relevant anatomy and discuss TMR nerve transfer options available for patients with amputations at varying levels including partial hand, trans-radial, trans-humeral and shoulder disarticulation.