Targeted Muscle Reinnervation for Management and Prevention of Symptomatic Neuroma

Symptomatic neuroma formation after peripheral nerve injury poses a major clinical challenge, contributing to chronic neuropathic pain, which is reported by approximately 60% of residual limb patients. Traditional neuroma management approaches, featuring passive techniques such as neurectomy and nerve burial in muscle, have shown limited success with relatively high recurrence rates and fail to address the fundamental pathophysiology of misguided axonal regeneration. The past two decades have witnessed a fundamental transformation toward active nerve reconstruction management strategies, prominently featuring targeted muscle reinnervation (TMR). Originally developed for myoelectric prosthetic control, TMR has had a significant impact on the field of peripheral nerve surgery through its efficacy in preventing and treating neuropathic pain. TMR provides physiologic targets for organized axonal regeneration while potentially interrupting the peripheral-to-central pain cascade that characterizes chronic neuropathic pain. Level I evidence demonstrates superior outcomes compared to traditional treatments, with TMR providing sustained pain relief in 82% of patients. Beyond pain reduction, TMR has demonstrated improvements in quality of life, sleep, and psychosocial well-being, suggesting its effects on inhibiting central sensitization mechanisms. Applications of TMR have expanded beyond amputees to include myriad anatomic locations, representing a transition from experimental prosthetic applications to comprehensive neuropathic pain management. As understanding of peripheral nerve biology and neuropathic pain advances, TMR is positioned to play an increasingly important role in personalized nerve surgery. The growing international adoption offers hope for reducing the global burden of chronic neuropathic pain through focused interventions that address both peripheral and central pain mechanisms.