TMR (Targeted Muscle Reinnervation) surgery allows a prosthetic arm to respond directly to the brain’s signals through the surgical transfer of residual arm nerves to alternative muscle sites, such as the chest (shoulder disarticulation) or upper-arm (transhumeral amputation). The goal of this procedure is for the patient to have simultaneous control of multiple degrees of freedom in a prosthesis.


A good candidate for TMR surgery is a patient who has a positive attitude, is motivated, functional, and wanting to learn. A patient also needs to have an intact brachial plexus, the complex network which supplies nerves to the chest, shoulder, and arm.

While TMR surgery has been primarily performed on shoulder disarticulation and transhumeral amputees, the technique is now being extended to patients who have had lower-limb amputations.


The first noticeable reinnervation usually occurs at 10 to 15 weeks after surgery when a small twitch is felt or seen in the target muscles in the chest or upper arm. Learning how to train those newly reinnervated muscles in occupational therapy is a process ranging from four to seven months, depending on the individual.

During occupational therapy, the patient strengthens reinnervated muscles to generate electromyogram (EMG) signals, detectable by surface electrodes. These signals allow the patient to gradually master the art of knowing which muscles control movement. Because nerve endings are redirected and now have a purpose, some patients have found that phantom pain is quite often reduced or eliminated.


TMR Surgery is covered by Medicare and Workman’s Comp because it is a functional operation, not cosmetic. However, each patient should check with their own insurance carrier. Northeast Advanced Surgery and Prosthetics can help with this.

What Is TMR Surgery?

Read more about this amazing surgery that allows a prosthetic arm to respond directly to the brain's signals.

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