Novel Use of Targeted Muscle Reinnervation in the Hand for Treatment of Recurrent Symptomatic Neuromas following Digit Amputations

Abstract

Summary: Targeted muscle reinnervation (TMR) has been shown to decrease neuroma pain after major limb loss; however, it has not previously been described for the treatment of symptomatic neuromas in the hand after digit amputations. This report describes the use of TMR in the hand for treatment of a patient with recurrent neuromas after ray amputation of the index and long fingers that were refractory to traditional treatments. TMR was performed first for the superficial branch of the radial nerve 6 years ago to treat the dorsal neuroma pain. Following this, there was complete resolution on the dorsal aspect of the hand, however, continued neuroma pain on the volar aspect of the hand. This was treated more recently with excision of the neuromas and TMR to motor branches of the intrinsic muscles of the hand. Outcomes were measured with a numerical rating scale and Patient-Reported Outcomes Measurement System assessments and revealed decreased pain postoperatively and less interference of her activities due to pain. This report demonstrates the ability to perform TMR within the hand with good results when used for the treatment of symptomatic neuromas.