Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, refractory phantom limb pain (PLP) following [Level of Amputation]. Pain is described as [burning/stabbing/electric], occurring [frequency] with a severity of [0-10] on the NRS. Symptoms are exacerbated by [triggers]. Patient reports failure of conservative management, including pharmacotherapy (gabapentinoids/TCAs) and physical therapy. Patient is seeking evaluation for Targeted Muscle Reinnervation (TMR) to address symptomatic neuromas and improve prosthetic tolerance.
Clinical Examination Findings
Physical examination of the residual limb reveals [well-healed/scarred] incision. Palpation identifies focal, exquisite tenderness at the site of suspected terminal neuromas, reproducing the patient's phantom sensations (Tinelโs sign positive). Skin integrity is intact with no signs of infection. Assessment of muscle bulk and motor function of remaining proximal musculature is performed to evaluate suitability for TMR nerve transfers. Neurovascular status is intact.
Treatment Protocol
Plan: 1. Electromyography (EMG) and nerve conduction studies to map donor/recipient nerves. 2. Pre-operative optimization of pain management. 3. Surgical intervention: Targeted Muscle Reinnervation (TMR) involving neurectomy of symptomatic neuromas and coaptation to motor nerve branches of proximal muscles. 4. Post-operative physical and occupational therapy for neuromuscular re-education and prosthetic integration.