Nerve Injury and Limb Pain Program

Nerve injuries—including those from crushes, lacerations, and amputations—can lead to devastating and debilitating pain. 

Some of the surgical techniques used to solve these problems include:

Targeted Muscle Reinnervation (TMR)

The transfer of damaged nerves into healthy targets can help break the pain cycle for many patients. Intraoperative nerve stimulation aids the surgeon in finding an appropriate target for transfer that will allow the nerve to regenerate without causing loss of function.

Regenerative Peripheral Nerve Interface (RPNI)

Muscle grafts can be harvested and used to provide a healthy target for a damaged nerve to regrow without pain.

Nerve Capping (Nerve End Capping)  

This procedure involves sealing or covering the cut end of a peripheral nerve, typically after a surgical amputation or traumatic injury to reduce the risk of neuroma formation and decrease pain.

Pedicled Vascularized RPNI (vRPNI)

In this modification of the traditional RPNI procedure, instead of using free muscle tissue, a piece of muscle with its blood supply intact is used.

Vascularized, Denervated Muscle Targets (VDMTs)

This surgical approach—which provides a high-fidelity signal for prosthetic control while simultaneously preventing and treating neuroma pain—was designed to improve the interface between residual peripheral nerves and prosthetic devices, especially in patients who have undergone limb amputations. 

Burying the Cut Nerve in Muscle or Bone

With this technique, a surgeon will typically trim away any scarred or damaged tissue from the cut end of a nerve at risk for forming a neuroma (or that is already forming a neuroma), creating a healthy environment for the nerve to heal, away from external stimuli.

Nerve Repairs/Grafting

A cut nerve or damaged nerve segment can be repaired, or removed and replaced with a graft. This allows for controlled, healthy regrowth of the nerve.

Neurolysis/Soft Tissue Coverage

Occasionally, an otherwise healthy nerve is compressed or embedded in a scar and cannot glide. Removing the compression or scar tissue and ensuring the nerve rests in a healthy soft tissue bed can alleviate pain for many patients.

Additional Resources

• Why does my arm hurt?
• What actually causes hand numbness and pain?

More info:

What is TMR?

https://www.tmrnerve.com/
https://rethink-pain.com/

Immense gains have been made in maximizing functionality and minimizing pain for patients who have lost limbs due to trauma. Our team helps guide patients at all stages of reconstruction—from initial treatment of traumatic injuries to late-stage reconstruction. We work closely with prosthetists to offer customized solutions and customized surgery focused on each individual situation.

Targeted Muscle Reinnervation

Rerouting cut nerves into underutilized muscles can greatly decrease pain and greatly increase the use of specialized prostheses designed to be controlled by electrical signals in the muscles.

Prosthesis Fitting

Maximizing functional outcomes requires customized care from specialized prosthetists who can help to address each individual’s needs. Comfort, fit, durability, stability, and control are all balanced on an individual basis.

Soft Tissue Coverage

Bone, scar, nerve, or unhealthy tissue may need to be covered or realigned to facilitate a stable limb that can effectively interface with a prosthesis.

Common Prosthetic Options for Amputees

Cosmetic, static, body-powered, and myoelectric devices are commonly generated for our patients with limb loss.

Learn More about the Amputee Coalition

Additional resources 

• Phantom nerve pain after limb amputation 
• What causes stump pain? 

The brachial plexus is a complex network of nerves that arises from the neck and controls all the muscle and sensory functions of the arm. It usually arises from five nerve roots in the neck and forms connections and terminal nerves in predictable patterns. Due to the unique anatomy, patients will have highly variable presentations that range from the limitation of single joints to complete dysfunction of the entire arm. Treatment of these injuries requires careful diagnosis and a customized approach.

https://ubpn.org/

Nerve Transfers

Healthy, undamaged nerves can be re-routed into injured nerves to try and reawaken paralyzed muscles. These nerves may come from unaffected parts of the brachial plexus, or from other sources such as the rib cage or upper shoulder and back.

Nerve Grafts

Areas of damaged nerves can be removed and replaced with nerve grafts to try and facilitate regrowth of the nerve.

Tendon Transfers

Muscles that remain functional can be rerouted to provide function that was otherwise lost.

Muscle Transfers

Some patients may be candidates for moving healthy muscles from other parts of the body into the arm.

Joint Fusions

At times, joints that have lost mobility can be stabilized by fusing the joint and trading weak motion for stability.

What to know about brachial plexus injuries