Shoulder disarticulation externally powered prosthetic fitting following targeted muscle reinnervation for improved myoelectric control

Functional prosthetic restoration is challenging for individuals with high-level upper extremity amputations. It is of greater consequence when the individual has sustained bilateral limb loss. It is possible to denervate expendable regions of muscle in or near an amputated limb and transfer the residual peripheral nerves to this muscle. The surface EMG signals from the reinnervated muscle can then be used as additional control signals for an externally powered prosthesis. This technique, called "targeted reinnervation," allows the simultaneous control of multiple degrees of freedom in a prosthesis. Control of the prosthesis is also easier and more natural because the myoelectric signals are physiologically correlated to the movements of the lost arm and could greatly improve the function of myoelectric prostheses. The authors describe the first application of targeted reinnervation to a man with bilateral shoulder disarticulation amputations, with a focus on the prosthetic fitting and its challenges. The surgical procedure and preliminary outcomes are presented.