Targeted Muscle Reinnervation to Expendable Motor Nerves for the Treatment of Refractory Symptomatic Neuromas in Non-Amputees
Brian L Chang, MD1, Josh Mondshine, BS1 and Grant M. Kleiber, MD2, (1)Georgetown University, Washington, DC, (2)Medstar Georgetown University Hospital, Washington, DC
Introduction
Symptomatic neuromas can cause debilitating pain, significantly impairing patientsÕ quality of life. There are numerous medical and surgical options for management. Targeted muscle reinnervation (TMR) is a nerve transfer procedure that is now commonly used to prevent or treat symptomatic neuromas or phantom limb pain in amputees, but its use to treat symptomatic neuromas in non-amputees has not been reported. This study evaluates TMR to treat symptomatic neuromas in non-amputee patients.
Materials and Methods
This is a retrospective cohort study of all patients with symptomatic neuromas treated with TMR over a 1-year period from 1/1/2019 to 1/1/2020. The neuromas are excised to healthy nerve fascicles, and a redundant donor motor fascicle is selected for nerve transfer. Operative notes were reviewed for intra-operative findings of a terminal neuroma and the selected motor target. Patients were asked about their pre-operative and post-operative pain, function, and quality of life, and post-operative clinic notes were reviewed for complications and motor deficits.
Results
15 patients were included in this study. Patients had symptomatic neuromas involving the upper extremity, lower extremity, and trunk. Pain frequency decreased from 6.7 times per week to 3.9 (P < 0.01) and from 9.1 times per day to 5.1 (P < 0.01). Pain severity decreased from an average of 7.9/10 to 4.3/10 (P < 0.01). Overall physical function increased from 3.7/10 to 5.8/10 (P = 0.01), and overall quality of life increased from 4.9/10 to 7.0/10 (P < 0.01). No patients had demonstrable weakness of the motor function of the donor nerve.
Conclusions
Targeted muscle reinnervation is a viable surgical option for the treatment of symptomatic neuromas, particularly in those patients who have previously failed prior neuroma excisions.
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