Targeted muscle reinnervation to avoid neuroma or nerve injury

Targeted muscle reinnervation to avoid neuroma or nerve injury

Major limb amputations produce a deficit of form and function but also cause post-amputation pain that can manifest itself for weeks, months or even years to come. This pain often affects quality of life, impacts the daily routine, affects interpersonal relationships, and may eventually increases the risks of depression. 

Targeted muscle reinnervation (TMR) is a procedure to treat or prevent chronic neuropathic pain in amputees. 

After nerve injury, patients develop painful neuromas at the endpoints. When a nerve is injured or amputated, it tries to regenerate. But the nerve does not have a clear target to grow. This results in the accumulation of a disorganised mass of nerve tissue called a neuroma.


Indications for TMR nerve surgery

There are three common indications for TMR surgery: 

  • Non-reconstructable neuroma treatment
  • Management of nerve endings in acute amputations 
  • Treatment of chronic amputation stump or phantom limb pain


Why does nerve pain develop after amputation? 

Amputees experience nerve pain primarily due to the following two conditions.

 Neuromas: A nerve is like a live wire. Once the wire is severed, electrical shocks continue to flow till the ends, but they have nowhere to go once the limb is removed. These disorganised nerve endings that form tangles after amputation are called “neuromas.” They continue to send signals to the brain, interpreted as pain, and require a neuroma treatment. 

Phantom pain: When the limb is lost due to stabbing, shooting, or burning, pain seems to come from the limb that is no longer there. This pain can sometimes be so severe that it impacts daily life. 

Read More- How TMR helps treat Phantom Limb Pain

TMR nerve surgery: Procedure & Significance

While other therapies also exist to manage post-amputation pain, TMR surgery is gaining acceptance as the best treatment for nerve pain associated with amputation. It works by giving the nerve “ somewhere to go, and something to do” – by connecting them to nearby muscles that have been rendered functionless by the original amputation.

Targeted muscle reinnervation (TMR) involves rerouting the residual nerve end to a motor nerve that is no longer functional and useful. TMR surgery is performed close to its entry point into the muscle. 

TMR surgery was originally developed for improving the control of upper limb prosthetics. However, after research, amputation doctors observed reduced neuroma and phantom limb pain. The patients who underwent TMR surgery experienced less pain than those who received standard treatments for amputated nervIes.


TMR surgery recovery time

A TMR nerve surgery usually lasts for 2-4 hours and a hospital stay ranging from 1-5 days, depending on the extent of the surgery, recovery and post-operative needs. Post-surgery follow-ups are also planned to monitor the recovery.

If you plan to have prosthetic and targeted muscle reinnervation at the time of amputation, the fitting process may begin within 4-6 weeks. You can expect to receive the prosthesis around  8 weeks after surgery.

If you had TMR for nerve pain, you might be back to work as early as 2 weeks after surgery, depending on your work. For the first few days, surgical pain or inflammation may make it difficult to wear your prosthetic device. Talk to your amputation doctor about any discomfort or pain you experience during recovery.



Chronic neuropathic pain after amputation procedures is a challenging and impairing problem. Early results of TMR in the lower limb have shown great promise in preventing or treating neuroma pain. Therefore, it may be offered during amputation as a preventative measure.

Dr Demetrius has extensive experience in performing TMR surgery on amputees. He has worked many years of service in the Royal Air Force Medical Branch as a doctor. If you are looking for amputation or TMR surgery in Dubai, book your appointment with Dr Demetrius today.

Dr. Demetrius

Dr Demetrius Evriviades-

BSc(Hons), MB ChB, PGDip, FRCS(Plast) CCT-UK

Dr Demetrius Evriviades is a UK- trained Consultant Plastic Surgeon with 20+ years of experience in plastic reconstruction, amputation rehabilitation, and targeted muscle reanimation (TMR). He has helped more than 200 young amputees worldwide with the latest surgical and therapeutic techniques to manage pain and improve function.