Upper Extremity Amputee Neuroma Cases

Postamputation pain management remains a difficult problem to treat. Upper extremity amputations present a unique challenge in part due to the large number of nerves transected as well as their superficial position in the residual limb, leaving these patients at increased risk for symptomatic neuroma formation. Targeted muscle reinnervation (TMR) and creation of regenerative peripheral nerve interfaces (RPNI) are new surgical techniques that have been shown to reduce both residual limb pain and phantom limb pain in amputees. The current literature supports that these techniques successfully ameliorate neuroma symptoms more effectively than traditional methods such as traction neurectomy or burying nerve ends in muscle or bone. The indications for these procedures are expanding, while the best surgical candidates and timing for intervention continue to be investigated. In this chapter we describe the surgical technique for neuroma management in partial hand, transradial, transhumeral, and shoulder disarticulation amputations.