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In Sight: Targeted Muscle Reinnervation

In Sight: Targeted Muscle Reinnervation 150 150 Abbie Miller

Amputation in pediatrics is often a result of traumatic injury or cancers, such as osteosarcoma. At Nationwide Children’s, Thomas Scharschmidt, MD, director of the Orthopedic Oncology Program, is a leader in limb salvage surgery and targeted muscle reinnervation. 

Targeted muscle reinnervation (TMR) is a surgical technique that reroutes severed peripheral nerves into nearby muscles, giving those nerves a new functional target and restoring a pathway for communication with the brain. By helping prevent painful nerve-related complications after surgery, TMR can reduce postoperative pain in the short term while also creating the foundation for more advanced prosthetic control in the future. Through these redirected nerve signals, patients may eventually be able to interface with bioprosthetic devices in a more natural and responsive way. TMR is usually done at the time of amputation, but Dr. Scharschmidt says data shows benefits of secondary TMR for adults. Data for secondary TMR is limited in children.

Differences In Nerve Pathways Before vs. After Targeted Muscle Reinnervation

Amputated nerves of the upper extremity at high risk of neuroma formation, pain, difficulty with prosthetic wear.

In TMR, peripheral nerves cut during amputation are connected to motor nerve branches in remaining muscles. This approach offers a reduction in phantom limb pain and residual limb pain in the long term, as well as an option for improved bioprosthetic use.

Amputated nerves connected to distal motor nerves for TMR. Mixed motor and sensory nerves divided with amputation of upper extremity.

Read About TMR Research

Image credits: Amplify Biosciences for Nationwide Children’s Hospital

Expert reviewers: Thomas Scharschmidt, MD, and Kim Bjorklund, MD

About the author

Abbie (Roth) Miller, MS, MWC, is a passionate communicator of science. As the manager of medical and science content at Nationwide Children’s Hospital, she shares stories about innovative research and discovery with audiences ranging from parents to preeminent researchers and leaders. She is a Medical Writer Certified®, credentialed by the American Medical Writers Association, and received her masters of science in Health Communication from Boston University.

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