Background/Objectives: Neuropathic pain associated with neuromas is a complex clinical problem to treat. Targeted Muscle Reinnervation (TMR) has been demonstrated to treat pain both as a prophylactic procedure in amputated patients and in patients affected by painful neuromas. It is not clear what its role could be in chronic situations: the literature reports amazing results but also unsuccessful pain relief. Methods: A retrospective analysis was conducted on patients treated with TMR for long-lasting painful neuromas in the upper and lower limbs. Following a clinical and instrumental diagnosis, all patients responded positively to a local anesthetic block. During follow-up visits, the NRS and DN4 questionnaires were used to assess improvement in pain. Results: Three patients were included in this study. TMR was performed 45 months after trauma. Two TMRs involved nerves of the upper extremity, in one case, the tibial nerve. The recipient muscles were the second lumbricalis, pronator quadratus, and flexor digitorum longus of the foot. After surgery, pain decreased for 3 months, but patients experienced a relapse that returned to levels close to the pre-operative period. The types of pain, as reported in DN4 questionnaire, changed slightly compared to those in the pre-surgical period. Follow-up ranged between 12 and 19 months. Conclusions: This small series collected the results of TMR in patients affected by long-lasting symptomatic neuromas in the upper and lower extremities. Despite what is published in other series, this procedure reduced pain for up to 6 months. At final follow-up, the type of pain changed slightly as reported in the DN4 questionnaire, and pain scores reduced by just one point as shown by the NRS. Our experience suggests that TMR might have a slight effect on long-lasting painful neuromas and in these cases, only short-term pain relief could be expected. This suggests using TMR as close as possible to the trauma in order to increase the chances of relieving pain.

Introduction: The Oberlin nerve transfer is widely used to restore elbow flexion after brachial plexus injury. However, donor-site morbidity, particularly permanent motor deficit, has been rarely reported. This retrospective case series describes permanent donor-site morbidity following the Oberlin procedure and explores its association with poor elbow flexion outcomes. Methods: Nine patients (mean age, 38 years) with upper-type brachial plexus paralysis, including seven C5–C8 injuries, were referred to a tertiary centre after undergoing a primary Oberlin transfer at external institutions. All patients described immediate hand paralysis and/or failure of elbow flexion recovery after the surgery. Patients were reassessed at a mean follow-up of 27 months (range, 9–48). Outcome measures included assessment of hand motor deficits, grip strength and elbow flexion recovery using the Medical Research Council scale. Results: Six of nine patients failed to achieve functional elbow flexion (M0, n = 4; M2, n = 2). Eight patients had ulnar nerve involvement, most commonly paralysis of the first dorsal interosseous muscle ( n = 7) and clawing deformity ( n = 6). One patient exhibited isolated anterior interosseous nerve paralysis. Mean grip strength was markedly reduced, averaging 14 kg compared with reported normal values of 30–50 kg. Conclusions: The frequent association between irreversible hand weakness and unsatisfactory elbow flexion recovery highlights the limited functional reserve of donor nerves in selected clinical scenarios. These findings emphasize careful patient selection and microsurgical expertise in Oberlin transfers. Level of evidence: IV