[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-442851-105":59,"doc-detail-442851-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","targeted-muscle-reinnervation-to-lumbrical-muscles-for-symptomatic-digital-stump-neuroma-surgical-technique","Targeted Muscle Reinnervation to Lumbrical Muscles for Symptomatic Digital Stump Neuroma - Surgical Technique","","Targeted muscle reinnervation (TMR) provides a strategy for symptomatic digital stump neuromas by redirecting axonal growth from neuropathic sensory nerves to nearby motor endplates, potentially reducing neuroma recurrence compared with traditional passive procedures. The article presents an anatomically validated, step-by-step surgical technique for applying TMR to lumbrical muscles, including positioning, tourniquet management, incision planning, recipient nerve identification, neuroma excision, nerve lengthening, and tension-free coaptation, supported by graphic, photographic, and video illustrations to promote reproducibility.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/targeted-muscle-reinnervation-to-lumbrical-muscles-for-symptomatic-digital-stump-neuroma-surgical-technique/442851/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/targeted-muscle-reinnervation-to-lumbrical-muscles-for-symptomatic-digital-stump-neuroma-surgical-technique/442851.png","ImageObject",300,407,{"name":92,"@type":93},"mieayamfan","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What problem does targeted muscle reinnervation (TMR) address in digital stump neuromas?","Question",{"text":113,"@type":114},"TMR aims to treat symptomatic stump neuromas by redirecting axonal growth from sensory nerve sources to suitable motor endplates, which may help prevent neuroma recurrence.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Why does the technique emphasize total digital nerve excision rather than only a proximal neurotomy?",{"text":118,"@type":114},"The approach prefers excising the entire digital nerve with the neuroma to reduce the risk of collateral sprouting from the contralateral digital nerve causing aberrant reinnervation.",{"name":120,"@type":111,"acceptedAnswer":121},"How is the recipient motor entry point (MEP) to the lumbrical muscle identified in the procedure?",{"text":122,"@type":114},"The motor entry point is located about 20 mm proximal to the proximal border of the A1 pulley, and recipient nerve identity is verified with handheld electrical stimulation before marking for coaptation.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},442851,1790818356,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},962090893677,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Ideas aNd INNovatIoNs   \nPeripheral Nerve  \nTargeted Muscle Reinnervation to Lumbrical  \nMuscles for Symptomatic Digital Stump Neuroma: Surgical Technique  \nOlga Politikou, MD Michael A. Wirth, MD Martina Greminger, MD Inga S. Besmens, MD Maurizio Calcagni, MD  \nSummary: Targeted muscle reinnervation (TMR) represents a significant advancement in treating symptomatic stump neuromas. Unlike traditional passive procedures, TMR redirects axonal growth from sensory nerves to motor endplates, which may help prevent neuroma recurrence. This study detailed the surgical steps involved in applying TMR to the lumbrical muscles, supported by graphic, photographic, and video illustrations, aiming to ensure reproducibility. (Plast Reconstr Surg Glob Open 2026;14:e7390; doi: 10.1097/GOX.0000000000007390; Published online 6 January 2026.)  \nINTRODUCTION  \nFinger amputation inevitably results in neuroma formation, although these are often asymptomatic. The true incidence of painful stump neuroma is unknown, but has been reported as high as 7% .1 Traditional surgical treatments, such as traction neurectomy, nerve implantation into adjacent tissue (eg, bone or muscle), nerve capping, and centrocentral anastomosis, often yield inconsistent results.2 Targeted muscle reinnervation (TMR), originally developed to enhance intuitive prosthesis control, shows promising outcomes and is gaining acceptance among surgeons for addressing this challenging clinical issue.3 It involves coapting the neuropathic sensory nerve to a nearby expendable motor branch, offering viable motor endplates for axonal growth and reducing neuroma formation.4,5 In cases of partial hand and finger amputations, cadaveric dissection studies have identified suitable expendable motor branches of intrinsic hand muscles as recipients, demonstrating consistent anatomy.6 Recent case reports have shown successful clinical outcomes in  \nFrom the Division of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.  \nReceived for publication February 11, 2025; accepted November 14, 2025.  \nPresented at the 78th Annual Meeting of the American Society for Surgery of the Hand, October 5–7, 2023, Toronto, ON, Canada; Congress of the Swiss Society of Hand Surgery, November 23–24, 2023, Interlaken, BE, Switzerland; and Annual Meeting European Association of Plastic Surgeons, May 29–June 1, 2024, Athens, Greece.  \nCopyright © 2026 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.  \nDOI: 10. 1097/GOX.0000000000007390  \nterms of residual and phantom limb pain relief.7,8 This study aimed to provide a comprehensive, step-by-step description ofTMR to the lumbrical muscles for the treatment of symptomatic digital stump neuromas.  \nSURGICAL TECHNIQUE  \nThe patient is positioned supine under general anesthesia, without the use of muscle relaxants. An upper arm tourniquet is applied from the beginning of the procedure. The neuroma is marked on the skin preoperatively. A Bruner incision is planned with an extension into the palm toward the target lumbrical muscle.  \nAs the entire surgery is performed under an arm tourniquet, the procedure starts with the dissection and stimulation of the chosen recipient nerve in the palm without exceeding the 30-minute tourniquet time, thus preventing ischemic muscle paralysis. The motor entry point (MEP) to the lumbrical muscle is found approximately 20 mm proximal to the proximal border of the A1 pulley (authors’ observation in cadaveric dissections, not published), which is consistent with the findings of Colonna et al,9 with the nerve located medially and dors","cbCaieFW6Qtw2i3A","https://ap.wps.com/l/cbCaieFW6Qtw2i3A","pdf",1211449,"English","# Introduction\n# Surgical Technique\n# Takeaways","[{\"question\":\"What problem does targeted muscle reinnervation (TMR) address in digital stump neuromas?\",\"answer\":\"TMR aims to treat symptomatic stump neuromas by redirecting axonal growth from sensory nerve sources to suitable motor endplates, which may help prevent neuroma recurrence.\"},{\"question\":\"Why does the technique emphasize total digital nerve excision rather than only a proximal neurotomy?\",\"answer\":\"The approach prefers excising the entire digital nerve with the neuroma to reduce the risk of collateral sprouting from the contralateral digital nerve causing aberrant reinnervation.\"},{\"question\":\"How is the recipient motor entry point (MEP) to the lumbrical muscle identified in the procedure?\",\"answer\":\"The motor entry point is located about 20 mm proximal to the proximal border of the A1 pulley, and recipient nerve identity is verified with handheld electrical stimulation before marking for coaptation.\"}]","Targeted Muscle Reinnervation to Lumbrical Muscles for Symptomatic Digital Stump Neuroma - Surgical Technique | PDF",1790701860,15]