Learn the Targeted Muscle Reinnervation (TMR) for neuroma treatment following above knee amputation surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Targeted Muscle Reinnervation (TMR) for neuroma treatment following above knee amputation surgical procedure.
There are various potential sources of chronic nerve pain following amputation but approximately one quarter of lower limb amputees will develop chronic nerve pain specifically due to a symptomatic neuroma within the stump. Chronic nerve pain is a major source of disability in some patients following limb amputation, reducing engagement with rehabilitation programmes and tolerance of prosthetic use. There is an accompanying burden of psychosocial morbidity.
Treatment of symptomatic neuromas is a challenge for the whole pain team as well as the peripheral nerve surgeon.
Various surgical techniques are described, and varying degrees of success reported for each.
During lower limb amputation surgery peripheral nerves are often divided under traction, allowing them to retract away from the stump into healthier tissue. This method however can lead to neuroma formation with spontaneous and evoked pain as well as allodynia, hyperalgesia and dysaesthesia, hallmarks of central sensitisation.
Surgical treatment for an end neuroma may involve use of a capping device, burial of the stump within muscle or within a cortical bone window or anastomosis to another nerve or a a long nerve ‘graft to nowhere’. Results of these techniques are inconsistent, and treatment of these patients remains difficult.
Targeted muscle reinnervation (TMR) involves a nerve transfer of the residual nerve end to a motor nerve that is no longer useful. This is performed as close as possible to its entry point into the muscle.
TMR has shown success in the upper limb where it has been used to generate physiologically appropriate electromyography signals within muscles of the residual limb for prosthetic control. Significant reductions in neuroma pain have also been noted in these patients.
Early results of TMR in the lower limb have shown promise in preventing or treating neuroma pain. It may be offered at the time of amputation as a preventative measure, or in the treatment of established, symptomatic neuroma in an amputation stump.
Coapting sectioned nerve stumps onto recipient motor nerve branches encourages nerve regeneration into the target muscle, preventing the formation or recurrence of neuroma.
In this section the workup and surgical technique in a patient with an established end neuroma following an above knee amputation stump is described.
Readers will also find the following OrthOracle surgical techniques of interest:
Author:Tahseen Chaudhry, Consultant hand and peripheral nerve surgeon
Institution: University Hospital Birmingham, Birmingham, UK
Each operation and the questions associated become a named course in the CPD section
The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
There are four possible answers of which one is correct (or on occasion more correct) than the others.
There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
The course is completed once all the lessons are read and quizzes submitted and passed.
On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
Your dashboard also will contain a record of the time you have spent logged onto and using the site.
The timer suspends after 5 minutes though if there is no activity.
When you restart you will resume at the same point in the module.
Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
The pass mark is 75%.
If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
Once these have been read you can re-do just the questions you failed on.
Once you have passed the quiz you can return at a future stage & resit .
CPD Points:
Operation Quiz – 1 CPD point
Surgical steps Quiz – 1/4 CPD point
Implants Quiz – 1/4 CPD point
Problem case Quiz – 1/2 CPD point
One CPD point equates to one hour of academic activity
COURSE
Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.
Our content is designed for both Surgeons in independent practice and Surgeons in training.