Targeted Muscle Reinnervation for the treatment of painful neuromas: a prospective cohort study.

Background: Peripheral neuromas commonly occur following nerve injuries. Targeted Muscle Reinnervation (TMR) has been gaining popularity in the treatment of painful neuromas. The aim of this study was to prospectively evaluate the effectiveness of TMR in the treatment of symptomatic neuromas.

Methods: The study prospectively followed patients treated for a symptomatic neuroma in the upper or lower extremity with TMR. Data was collected preoperatively, three months postoperatively, and 12 months postoperatively. The primary outcome was the pain score at rest on the 0-10 Visual Analog Pain score (VAS). Secondary outcomes included pain during activity, the percentage of patients with a postoperative VAS of or below three, and quality of life.

Results: Forty patients underwent TMR for a neuroma in the extremity. VAS pain levels at rest improved for 29 out of 40 participants (72.5%). Mean VAS pain score at rest improved significantly from 6.6±2.2 preoperatively to 4.3±2.7 at three-month follow-up and 3.7±2.8 at 12-month follow-up (p<0.001). Time interval from nerve injury to TMR was positively correlated with VAS pain score at 12-month follow-up (r=0.35, p=0.026). Quality of life improved significantly among participants, from an EQ-index score of 0.43± 0.26 preoperatively to 0.55±0.30 at 12-month follow-up (p=0.016).

Conclusions: TMR reduces limb pain in over 70% of patients with symptomatic neuromas and is associated with an improvement in quality of life. Further research is needed to identify prognostic factors for the success of TMR as well as establish its' effectiveness in comparison to other surgical treatments.