Targeted Muscle Reinnervation for the Treatment of Painful Neuromas: A Prospective Cohort Study.

BACKGROUND

Peripheral neuromas commonly occur after 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 observed patients treated for a symptomatic neuroma in the upper or lower extremity with TMR. Data were collected preoperatively and 3 and 12 months after surgery. The primary outcome was the pain score at rest on the 0 to 10 visual analog scale (VAS). Secondary outcomes included pain during activity, the percentage of patients with a postoperative VAS score of 3 or below, 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 3-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, from a EuroQoL 5D-5L 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 more than 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 to establish its effectiveness in comparison with other surgical treatments.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.