Intramuscular, Intraosseous, and Intravenous Implantation of Nerve in Treatment of Painful Peripheral Neuroma

Treatment of the painful neuroma in the year 2021 is accepted to include resection of the neuroma and doing “something” to the proximal end of that peripheral nerve. Today the choices are to transpose the proximal end into another tissue or convert the proximal end into something else, such as targeted muscle reinnervation (TMR) or a regenerative peripheral nerve interface (RPNI). This chapter reviews transposing a nerve (1) into a muscle, which began in 1984 and has become the gold-standard approach, yielding up to an 80% success rate for both upper and lower extremity nerves; (2) into a bone, which began in 1920 and is still useful when no adjacent muscle is available; and (3) into a vein, which began in the year 2000 and remains a useful alternative if a muscle or bone is not available. Implanting the proximal end of the nerve into a muscle is efficient and cost-effective, requiring minimal dissection and essentially no extra operating room time or microsurgery techniques for nerve repair (TMR) or muscle grafts (RPNI).