Targeted Muscle Reinnervation for Prosthetic Control

Targeted muscle reinnervation (TMR) is a surgical procedure, whereby nerves without muscle targets after extremity amputation are transferred to residual stump muscles. Thereby, the control of prosthesis is improved by increasing the number of independent muscle signals. The authors describe indications for TMR to improve prosthetic control and present standard nerve transfer matrices suitable for transhumeral and glenohumeral amputees. In addition, the perioperative procedure is described, including preoperative testing, surgical approach, and postoperative rehabilitation. Based on recent neurophysiological insights and technological advances, they present an outlook into the future of prosthetic control combining TMR and implantable electromyographic technology.