Phantom Limb and Neuroma Pain After Amputation: How Targeted Muscle Reinnervation (TMR) Can Help

By Dr. Oren Michaeli, DO – Board Certified General Surgeon, Fellowship-Trained in Hand Surgery, Microsurgery, and Peripheral Nerve Surgery

Phantom Limb Pain

Even after a limb is surgically removed, the nerves that once sent signals to and from that limb continue to transmit information to the brain. The result? You may feel sensations—such as burning, tingling, or cramping in the absent limb. This phenomenon is known as phantom limb pain. It can be distressing and confusing because the limb is no longer there, yet the pain feels very real.

• Key Point for Non-Medical Readers: Think of it like “memory pain”: the brain remembers the limb’s nerve pathways and continues to activate them as if the limb was still there.

• Key Point for Medical/Science Readers: This pain stems from maladaptive cortical reorganization and altered peripheral nerve signaling. The central nervous system pathways responsible for processing sensory input may become overactive due to a loss of the normal inhibitory feedback once provided by an intact limb.

Neuroma Pain

After an amputation, the nerves that were cut can sometimes form a bundle of scar tissue around the trimmed end. This bundle is called a neuroma. When nerves try to regenerate but have nowhere to go—because the distal targets (i.e., the tissue in the rest of the limb) are gone—they can end up forming these painful lesions. Neuromas can generate sharp, shooting, or electric shock-like sensations when touched or even spontaneously.

• Key Point for Non-Medical Readers: Imagine the nerve ending is like an exposed electrical wire. If it’s nudged, it can send a jolt of pain throughout the limb.

• Key Point for Medical/Science Readers: Neuromas develop as part of the normal healing process post-neurotmesis or axotomy. The unmyelinated axon sprouts congregate, creating a disorganized mass of fibrotic tissue that, when mechanically or chemically stimulated, triggers an intense nociceptive response.

The Impact on Daily Life

These conditions can make everyday tasks a struggle from walking and driving to simply sleeping through the night. Persistent pain also affects mental health, leading to anxiety, depression, or social withdrawal. Families and loved ones feel the ripple effects, too, often feeling helpless as they watch someone they care about suffer.

The good news is that medical advances like Targeted Muscle Reinnervation (TMR) can significantly reduce these issues, offering renewed hope and mobility.

A Real Patient Story: The 22-Year-Old Soldier

To illustrate how TMR and meticulous surgical care can transform lives, let me introduce you to a brave 22-year-old soldier (name withheld for privacy).

1. The Injury and Amputation

   • While serving in an armored vehicle, the soldier’s unit was struck by a projectile. The incident was caught on camera, and the emotional toll of later watching this footage was profound.

   • During lifesaving measures, his left leg was amputated below the knee. His right leg was peppered with shrapnel fragments, many of which caused neuromas because the nerve sheaths (epineurium) ended up wrapping around the embedded pieces of metal.

2. Ongoing Challenges

   • Nine months post-injury, he could barely walk due to severe pain in both legs—phantom pain in the amputated limb and neuroma pain where the shrapnel had lodged.

   • While on leave in New York, a friend suggested he visit my office for a consultation.

3. Surgical Intervention

   • After evaluating him, I recognized that Targeted Muscle Reinnervation combined with neuroma excision and careful reconstruction of his stump could significantly improve his situation.

   • In one operation, I revised his below-knee amputation on the left leg and performed TMR. On his right leg, I located and removed multiple neuromas, sometimes necessitating nerve grafting to bridge larger gaps.

4. Life After Surgery

   • Just two weeks later, this young soldier was up and about, even playing basketball.

   • Today, he’s living virtually pain-free and enjoying his favorite activities, such as attending Knicks games.

   • His remarkable recovery highlights how effective TMR can be for people suffering from phantom and neuroma-related pain.

What Is Targeted Muscle Reinnervation (TMR)?

In simple terms, TMR is a procedure that reroutes the nerves originally connected to the amputated limb into nearby functioning muscles. By doing so, these nerves get a new “home” to connect to, rather than forming painful neuromas at the amputation site.

• For Non-Medical Readers: Imagine a damaged highway exit that’s always causing traffic jams. TMR acts like a brand-new exit ramp directing traffic onto a smooth road. This reduces the “traffic jams” (neuromas) and the “phantom signals” that cause pain.

• For Medical/Science Readers: After identifying major peripheral nerves (e.g., tibial, peroneal in lower-limb amputations, or median, ulnar, radial in upper-limb amputations), these nerves are coapted (surgically attached) to motor nerve branches serving otherwise underutilized or “spare” target muscles. The nerve fibers then grow into these muscles, reducing disorganized nerve sprouting and decreasing the likelihood of painful neuroma formation.

Success Rates

While no procedure is 100% guaranteed, many studies—and my own clinical experience—indicate that TMR yields around an 80% improvement in pain symptoms for roughly 80% of patients. That level of relief can be life-altering for those battling daily discomfort.

Why Choose TMR at Hand Nerve Microsurgery?

1. Expertise You Can Trust:
   I’m Dr. Oren Michaeli, and I routinely perform TMR procedures either at the time of amputation or as a revision surgery many months—even years—afterward.

2. Supportive, Patient-Focused Approach:
   From the initial consultation to your final follow-up, we provide a luxury patient experience centered on your comfort and well-being. We understand how difficult and isolating the challenges of limb loss can be, and our team is here to support you at every step.

3. Insurance Solutions and Travel Assistance:

   • In many cases, we can arrange for insurance to cover the procedure, even if we’re out of network, so youwon’t be liable for the cost.

   • Depending on the specific policy, this can also include coverage for travel and lodging expenses.

   • We handle the insurance companies on your behalf, allowing you to focus on your recovery rather than paperwork.

You Are Not Alone

If you or someone you care about falls into the 87% dealing with phantom limb pain or neuroma pain, TMR may be the solution you’ve been searching for. There’s no need to suffer in silence or believe the pain is “all in your head.” We’re here to help you find freedom from ongoing discomfort and reclaim your life.

Schedule Your Consultation

To learn more about TMR and find out if it’s right for you, please call (212) 540-4263. For patients living in other states or abroad a Virtual Consultation can be arranged. We We’ll discuss your symptoms, walk you through the procedure, and explore all insurance options to ensure a smooth, supportive experience every step of the way.