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Targeted Muscle Reinnervation – amputation rehab

This summer, Boyes Turner attended Dorset Orthopaedic’s rehabilitation training day – an inspiring and thought-provoking day. We heard about the importance of rehabilitation, ‘pre-habilitation’ and why a rehabilitation programme must take place in the real world, not just a clinic.

It was also fascinating to hear Dr Norbert Kang, a Consultant Plastic Surgeon at Royal Free Hospital, talk about Targeted Muscle Reinnervation (TMR). TMR is a surgical procedure used to improve the control of upper limb prostheses. This is a procedure where residual nerves in muscles of an amputated limb which has lost its function, are transferred into another muscle to reinnervate new muscle targets. Dr Kang described how surgeons take stumps of nerves in muscles then reattach and use the muscles as an interface and amplifier of the amputated nerve motor signals. This allows for better control of prosthetic arms. Once patients have undergone TMR surgery, they are fitted with advanced pattern-recognition myoelectric prosthesis. The aim of TMR is to improve control and function by more subconscious and flowing movement, in transhumeral (above elbow) and glenohumeral (above shoulder) amputees. Dr Kang stated that in many of his patients, the surgery has eradicated or reduced pain by removing painful neuromas which can cause phantom limb pain or neuroma pain, usually within 6-12 months of surgery.

TMR is carried out on the NHS under the “reconstructive surgery” tariff in order to achieve pain relief with or without follow up rehabilitation. However, if the aim of surgery is to achieve better control of the upper limb prosthesis, once pain is controlled after surgery, patients must commit to a rehabilitation process. It is recommended that patients practice for between 4-5 hours a day using visual and memory to control movement in order to calibrate new muscle movement with that of their normal arm. Once they are able to calibrate movement with the unaffected limb, the prosthetic limb can be fitted with the use of a harness with a control panel.

TMR surgery can be done under the NHS to relieve pain which will is especially helpful for a client in pain and where liability is in dispute. If or when compensation does become available, Dr Kang stated that rehabilitation with the prosthetic limb can be carried out at a later stage in any event. Dr Kang recommended that a multi-disciplinary team approach be adopted to include the surgeon, prosthetist and pain specialist.

Sita Soni of Boyes Turner’s medical negligence team says “I was delighted to join Dorset Orthopaedics on their rehabilitation training day. It is always useful to obtain an update on the latest technology advances and therapy recommendations to help and support clients who have undergone an amputation and going through an amputation claim. It is also a great opportunity to catch up with other professionals, organisations and charities focused on supporting amputees including the Limbless Association. I look forward to next year’s conference!”

For information about amputation compensation claims talk to us confidentially and without any commitment or cost – call us on our free phone number 0800 029 4684 or email us at [email protected].

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Pretty Muddy for Cancer Research UK

On Saturday 15 July, Julie Marsh, Joanne Bayliss and Suzie Walker of Boyes Turner completed the Pretty Muddy challenge in order to raise funds for Cancer Research UK.

Pretty Mudder 2017

Julie has described the experience:

“A few months ago a friend asked me to complete this event with her. I did not hesitate and said yes.


Because she wanted to prove that she could do it and I wanted to help her achieve that goal.

Because she had just come through a really tough time fighting cancer recently, with such courage and fortitude, a smile (and a few tears) and beat the Big C.

Because my mum was affected a few years ago and it changed my family’s life forever.

I also wanted to complete the event because I wanted to remember that I am lucky enough to have my health (so far) and I needed to remind myself how lucky that makes me.

I had just about got my head around the fact that the distance was 5K, but it was only on Saturday morning when faced with a view of the crawl tunnels and muddy cargo nets that I remembered about the muddy obstacles that we would also have to overcome.

The atmosphere was really great with lots of people in colourful pink tutus and some sparkly face paint (which was soon covered in a layer of mud).

After the warm up we gathered as a group at the start line at 11 am and as soon as the buzzer went off we set off at a reasonable pace.

Pretty Mudder 2017


I was really proud that we managed to jog a lot of the course, considering quite a lot of it was up and down the hills in Prospect Park, Reading.

At the first obstacle, I was quite shocked to land in a great big puddle of mud, and the rest of the course was completed with very squelchy, muddy feet.

It was not until the fourth obstacle that I really got muddy, when I took a bucket full of muddy water in the face from one of the marshals.  He was clearly enjoying his job at the mud pit a little too much.


Our little team managed to complete the course in a respectable hour, and we stayed together throughout. It was great to be able to come down the mud slide at the end and cross the finish line together. It was actually a little bit emotional for all of us as well.

We were really lucky to have some great supporters pushing us on around the course, and it was a great experience. We are even talking about doing another one….

Pretty Mudder 2017

We would like to thank everybody who has supported us doing this event and to Cancer Research UK for arranging such a great local event”.

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Walking the Legal Walk & Talking the Legal Talk

On 22 May 2017, Sita Soni and Emily Hartland took part in the 10km London Legal Walk. The Legal Walk helps raise money for free legal advice charities who provide much needed free legal advice for those in need.

Walking the walk

The Legal walk was started in 2005 and 2017 set a new record with over 12,000 walkers taking part. The 10km walk started at the Law Society and the route passed various landmarks around London such as the Houses of Parliament and the Royal Courts of Justice. The sun was shining and spirits were high. TV Court Judge, Judge Rinder was involved and there was even some fancy dress.

AvMA Legal Walk 2017

Talking the talk

We teamed up with Action Against Medical Accidents (Avma) which is the UK charity for patient safety and justice. Avma works closely with medical professionals, the NHS, the government, solicitors and patients in order to improve patient safety. It also provides free independent advice and support to people affected by medical accidents.

AvMA Legal walk 2017

If it appears the patient could have a potential medical negligence claim, Avma put them in touch with solicitors like ourselves who can then investigate a possible claim.

We thoroughly enjoyed taking part and helping Avma raise money for the essential work they do. We’re looking forward to next year already.

If you or a member of your family have suffered disability as a result of medical negligence speak to one of our lawyers on our free phone number 0800 029 4682 or email us at [email protected].

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0800 307 7620