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

2020 ◽  
Vol 8 ◽  
pp. 205031212095918
Author(s):  
Blair R Peters ◽  
Stephanie A Russo ◽  
Julie M West ◽  
Amy M Moore ◽  
Steven A Schulz
Keyword(s):  
Functional Limitation ◽  
The United States ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Management Options ◽  
Prosthetic Limb ◽  
Targeted Muscle Reinnervation ◽  
Muscle Reinnervation ◽  
Residual Limb Pain

The life altering nature of major limb amputations may be further complicated by neuroma formation in up to 60% of the estimated 2 million major limb amputees in the United States. This can be a source of pain and functional limitation of the residual limb. Pain associated with neuromas may limit prosthetic limb use, require reoperation, lead to opioid dependence, and dramatically reduce quality of life. A number of management options have been described including excision alone, excision with repair, excision with transposition, and targeted muscle reinnervation. Targeted muscle reinnervation has been shown to reduce phantom limb and neuroma pain for patients with upper and lower extremity amputations. It may be performed at the time of initial amputation to prevent pain development or secondarily for the treatment of established pain. Encouraging outcomes have been reported, and targeted muscle reinnervation is emerging as a leading surgical technique for pain prevention in patients undergoing major limb amputations and pain management in patients with pre-existing amputations.

Preemptive Treatment of Phantom and Residual Limb Pain with Targeted Muscle Reinnervation at the Time of Major Limb Amputation

2019 ◽  
Vol 228 (3) ◽  
pp. 217-226 ◽  
Author(s):  
Ian L. Valerio ◽  
Gregory A. Dumanian ◽  
Sumanas W. Jordan ◽  
Lauren M. Mioton ◽  
J. Byers Bowen ◽  
...  
Keyword(s):  
Limb Amputation ◽  
Residual Limb ◽  
Limb Pain ◽  
Preemptive Treatment ◽  
Targeted Muscle Reinnervation ◽  
Muscle Reinnervation ◽  
Residual Limb Pain

scholarly journals Targeted muscle reinnervation in quadruple amputees: self-reported outcomes

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Emma-Leigh Rudduck ◽  
Frank Bruscino-Raiola ◽  
Margaret Angliss ◽  
Steven J Gray ◽  
David Lee Gow ◽  
...  
Keyword(s):  
Current Literature ◽  
Phantom Limb Pain ◽  
Phantom Limb ◽  
Residual Limb ◽  
Limb Pain ◽  
Targeted Muscle Reinnervation ◽  
Alfred Hospital ◽  
Muscle Reinnervation ◽  
Residual Limb Pain ◽  
Psychological Disabilities

Targeted muscle reinnervation (TMR) reduces pain and physical and psychological disabilities in amputees. We present the first two cases reported globally of quadruple amputees that underwent acute TMR. Each patient completed our novel ‘The Alfred Hospital Osteointegration Survey’ (TAHOS) for each limb at six, 12 and 24 months post amputation which evaluated aspects of prosthesis wear, neuroma-related residual limb pain (RLP), phantom limb pain (PLP) and overall function. Our findings that TMR reduced or eliminated RLP and PLP by 12 months and clinically improved prosthetic function in both quadruple amputees reflects the current literature for single and multiple limb amputees.

Targeted Muscle Reinnervation (TMR) at Time of Major Amputation Decreases Phantom and Residual Limb Pain

2018 ◽  
Author(s):  
Ian Valerio ◽  
Gregory A. Dumanian ◽  
Sumanas W. Jordan ◽  
Lauren M. Mioton ◽  
J. Byers Bowen ◽  
...  
Keyword(s):  
Major Amputation ◽  
Residual Limb ◽  
Limb Pain ◽  
Targeted Muscle Reinnervation ◽  
Muscle Reinnervation ◽  
Residual Limb Pain

scholarly journals Amputation, psychological consequences, and quality of life among Romanian patients

2020 ◽  
Vol 3 (1) ◽  
pp. 29-40
Author(s):  
Alin Cristinel Cotigă ◽  
Mirela Zivari ◽  
Adrian Cursaru ◽  
Cătălin Aliuş ◽  
Claudiu Ivan
Keyword(s):  
Quality Of Life ◽  
Psychological Health ◽  
Urban Areas ◽  
Psychological Symptoms ◽  
Demographic Data ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Depression And Anxiety ◽  
Symptoms Of Depression

AbstractAmputation of the limb is a major psychological health issue that was not fully studied. Patients and their families struggle with symptoms of depression, posttraumatic stress disorder, anxiety, phantom limb phenomena, etc. There is also a tremendous impact on the person’s quality of life.Aim: This study aimed to assess the psychological symptoms of depression, anxiety, and the quality of life among persons suffering from amputation of the limb.Methods: 31 respondents agreed to participate in the study. They were recruited from the Department of Orthopaedics and Traumatology, University Emergency Hospital, Bucharest, Romania. The medical conditions and the socio-demographic data (i.e., gender, marital status, income, etc.) along with the assessment of the psychological conditions and quality of life were contributions to the statistical analysis of the study.Results: This study showed that levels of depression are moderate to severe for a significant percent of the population (i.e., a “moderate to severe” or “severe” level of depression was presented by 29% of the patients according to the PHQ-9 test, and 16.1% of the patients according to Beck’s Depression Inventory). Moreover, the levels of anxiety were relatively higher than those of the general population (i.e., severe anxiety was confirmed by the GAD-7 test in the case of 38.7% of the patients) and for most of them the quality of life was impaired.Discussion: Amputation occurs mainly in adults/elderly aged over 50 years, married, living in urban areas, with different levels of depression and anxiety. At least half of them had a self-perceived health condition that was deteriorated, their physical and role functioning being primarily affected.Conclusion: There is a need for psychological support of the patients suffering from limb amputation as most of the studies showed high prevalence of depression and anxiety. Socio-demographic factors also represent important elements in defining the quality of life of those patients.

Development of Targeted Muscle Reinnervation Model in Hind Limb Amputated Rats

2018 ◽  
Vol 34 (07) ◽  
pp. 509-513 ◽  
Author(s):  
Rohit Garg ◽  
Safak Uygur ◽  
Joanna Cwykiel ◽  
Maria Siemionow
Keyword(s):  
Sciatic Nerve ◽  
Hind Limb ◽  
Femoral Nerve ◽  
Biceps Femoris ◽  
Limb Amputation ◽  
Sprague Dawley ◽  
Motor Branch ◽  
Targeted Muscle Reinnervation ◽  
Hind Limbs ◽  
Muscle Reinnervation

Background Targeted muscle reinnervation (TMR) is a novel approach to postamputation neuroma pain; however, this has not been explicitly studied. The purpose of this study was to develop a TMR model in hind limb amputated rats. Methods Ten hind limbs from 5 Sprague Dawley cadaver rats were used. Sciatic nerve, main branches of the sciatic nerve (common peroneal, tibial, sural), motor branches from the sciatic nerve to the biceps femoris and cauda femoris, gluteal nerve and its motor branches to the semimembranosus, and biceps femoris and femoral nerve were dissected to look for consistent nerve anatomy that can be used for TMR in the rat hind limb amputation model. Transfemoral amputation was performed and two types of coaptations were made: common peroneal nerve to motor branch to biceps femoris and tibial nerve to motor branch to semimembranosus. Results The total surgical time for the dissection, amputation, and coaptation of nerves was ∼90 minutes. A total of 100 nerves were dissected in 10 rat hind limbs. Anatomical dissections were straightforward to perform. Anatomy of the dissected nerves was consistent. Hind limb amputations were performed without damaging the target muscles and nerves. Nerve lengths were sufficient for coaptation without any tension. Conclusions To the best of our knowledge, this is the first report on TMR model in hind limb amputated rats. This model will allow for mechanical, electromyography (EMG), and histological analysis for future assessment of neuroma prevention.

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