Targeted muscle reinnervation (TMR) is one of the most exciting developments for amputee patients in several decades. Not only does the procedure help patients to use a prosthetic arm more efficiently, but it has also been found to cut down on limb pain and phantom pain. Gregory Dumanian, MD, FACS, is the originator of the TMR surgery and he first performed it 20 years ago. Here, he shares some information on the benefits of this important innovation.
What is TMR Surgery?
TMR was developed, with Dr. Todd Kuiken, a rehabilitation physiatrist, to provide arm amputees more control over their prosthetic arm. Compared to earlier, comparable procedures, patients find that they can move their arm, hand and fingers more smoothly and easily. They also experience less mental fatigue afterwards. TMR requires neither wires nor batteries to function.
TMR takes the amputated nerves and re-attaches them to smaller muscle nerves in the amputated limb. When successful reinnervation occurs, the amputated nerves are once again connected to living tissue, rather than acting like a “live electrical wire.” The amputated nerves have been given “somewhere to go and something to do.” A happy nerve is a nerve that forms a circuit with brain. The brain once again receives signals from the amputated nerve, and by this mechanism, phantom limb pain improves.
Expect Rehabilitation
Amputees need to work with their prosthetists for optimal limb rehabilitation. This is true with or without the TMR procedure. TMR makes moving the prosthetic limb more intuitive than standard prosthesis, but some rehabilitation work is still required. Prosthetists will work with the amputee to keep the socket well fitting and in the device in good working condition.
Consider the Timing of TMR
Research suggests that TMR is most successful in patients who have yet to experience nerve pain. What that means is that patients who are planning to have an amputation may want to schedule TMR immediately or soon after to maximize its benefits. They should discuss this option with their doctor as well as Dr. Dumanian.
Am I a TMR Candidate?
With that said, you may still be a strong candidate for TMR even if you have already had an amputation of your arm or leg. Dr. Dumanian has helped many patients to overcome existing nerve and phantom pain with TMR, including patients who have dealt with this pain for nearly a decade. Early treatment may be preferable, but TMR can still help to alleviate your pain and phantoms well after an amputation. It can sometimes take six months for an established phantom pain to improve or even disappear.
Interested in the Benefits of TMR?
No one knows how to perform and optimize TMR better than its creator, Dr. Dumanian. To make an appointment to discuss having an efficient prosthetic with minimal pain, call his office at Northwestern at (312) 695-6022.