This paper describes the surgical technique for targeted muscle reinnervation (TMR) in upper extremity amputees at the transhumeral and shoulder disarticulation levels. TMR redirects amputated nerve stumps into denervated muscle targets to generate intuitive myoelectric control signals for prosthetic devices. The authors detail nerve identification, transfer sequence, adipofascial flap placement, and postoperative rehabilitation milestones.
Upper extremity amputees fitted with conventional body-powered prostheses have limited control options, and postamputation neuroma pain has historically been managed with excision alone with high recurrence rates.
TMR addresses both problems with a single procedure: nerve transfers eliminate terminal neuromas by giving axons a muscle target, while simultaneously creating new myoelectric signals for prosthetic control.
When you evaluate a transhumeral amputee for prosthetic upgrade, confirm voluntary biceps and triceps function before offering TMR — these are the required muscle targets for the standard transfer pattern.
For shoulder disarticulation patients, confirm voluntary pectoralis, serratus, and latissimus function preoperatively, and obtain plain radiographs to determine whether the humeral head is present, since its absence shifts pectoralis anatomy 4 to 6 cm medially.
Counsel all TMR candidates that phantom pain will likely worsen for 4 to 6 weeks postoperatively before improving, and that prosthetic fitting cannot begin before 6 months regardless of how the wound heals.
This paper describes the surgical technique for targeted muscle reinnervation (TMR) in upper extremity amputees at the transhumeral and shoulder disarticulation levels. TMR redirects amputated nerve stumps into denervated muscle targets to generate intuitive myoelectric control signals for prosthetic devices. The authors detail nerve identification, transfer sequence, adipofascial flap placement, and postoperative rehabilitation milestones.
Upper extremity amputees fitted with conventional body-powered prostheses have limited control options, and postamputation neuroma pain has historically been managed with excision alone with high recurrence rates.
TMR addresses both problems with a single procedure: nerve transfers eliminate terminal neuromas by giving axons a muscle target, while simultaneously creating new myoelectric signals for prosthetic control.
When you evaluate a transhumeral amputee for prosthetic upgrade, confirm voluntary biceps and triceps function before offering TMR — these are the required muscle targets for the standard transfer pattern.
For shoulder disarticulation patients, confirm voluntary pectoralis, serratus, and latissimus function preoperatively, and obtain plain radiographs to determine whether the humeral head is present, since its absence shifts pectoralis anatomy 4 to 6 cm medially.
Counsel all TMR candidates that phantom pain will likely worsen for 4 to 6 weeks postoperatively before improving, and that prosthetic fitting cannot begin before 6 months regardless of how the wound heals.