Stump pain
The stump itself hurts: from pressure and chafing of the socket, scars, or damaged nerves.
CONDITION / ARMS AND LEGS
Upper limb amputation.
Amputation of an upper limb is the loss of part of the arm: hand, forearm, or shoulder — after injury, wound, or illness. After it, a person learns to live with or without a prosthesis, and a surgeon can help when the stump hurts, the prosthesis fits poorly, or the socket does not hold.
CONCEPTUAL VISUALIZATION- What it is
- Loss of part of the hand, forearm, or shoulder — after injury, wound, or illness.
- Level
- According to a systematic review, among major hand amputations, the level below the elbow occurs most frequently.
- pain
- According to a meta-analysis, 58% of people experience pain in the stump after hand amputation, and painful neuromas occur in 22%.
- Who helps
- Surgeon, prosthetist, rehabilitation specialist, occupational therapist, and psychologist — together.
01 / WHAT IS ITWhat does it mean?
What does it mean?
arm amputation.
Amputation is the removal of a part of a limb. A hand can be lost at the level of the hand, forearm (below the elbow), upper arm (above the elbow), or along with the shoulder joint. The level determines how many muscles and nerves remain in the stump, and therefore — which prosthesis can be controlled and what surgeries are possible.
An arm amputation can significantly limit daily activities. According to the clinical guidelines of the U.S. Departments of Veterans Affairs and Defense (2022), a person requires comprehensive rehabilitation at all stages — from surgery to living with a prosthesis.
This page is about what happens after an amputation and how a surgeon can prepare the stump for a modern prosthesis: reduce pain, provide clearer signals for a bionic hand, or attach the prosthesis to the bone. The prosthesis itself is made by prosthetists. Both military personnel and civilians seek help — immediately after hospitalization, years later, or even before a planned amputation.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSWhat people come with
What people come with
after arm amputation.
Most often, people are concerned about pain or a prosthesis that is difficult to use. These problems often occur together: a painful stump makes it difficult to wear a socket.
Painful point
Sharp pain in a certain spot of the stump when touched or pressed with a sheath — this is often how a neuroma manifests.
Stump neuromaPhantom pain
The hand that is no longer there hurts: burning, shooting, cramps. These sensations are not imaginary, they are real.
Phantom painThe prosthesis responds poorly
The bionic hand confuses movements, and there are not enough muscle signals from the stump to control it.
The sheath does not stay in place
Short stump, sweating, chafing; the prosthesis slips off or feels too heavy.
Problematic stump
Ulcers, unstable scars, bone under thin skin — wearing a prosthesis is painful or impossible.
Problematic stump03 / REASONSWhy do they lose?
Why do they lose?
arm.
The condition of the stump tissues and the problems a person faces after amputation depend on the cause.
Injury
According to a systematic review of global data, trauma is the most common cause of hand amputation. Amputation can result, for example, from limb crushing.
Injury
A review of military surgery notes: the energy of an explosion often causes large soft tissue defects, a higher level of amputation, and stronger pain afterward.
Fire woundDiseases
Severe limb infection, gangrene, or diabetic complications. According to the same review, among people with disabilities, diseases noticeably add to the causes of hand damage.
What increases the risk of phantom pain
According to meta-analysis: prolonged pain before surgery, higher level of amputation, stump pain, and phantom sensations.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Old amputation, stump pain, or an uncomfortable prosthesis — a planned situation, usually does not require emergency care. But after a recent surgery and in the presence of signs of infection or clot, do not delay.
103 immediately if:
- bleeding from the stump or wound does not stop despite pressure;
- the blood is gushing, bright red;
- it suddenly became difficult to breathe;
- breathing is very frequent;
- chest pain or pain in the upper back;
- the heart beats very often;
- the person fainted;
- confusion or slurred speech;
- blue, pale, or mottled skin or lips;
- very high or very low temperature, the person is shivering;
- rash that does not blanch when pressed.
Do not delay a visit to the doctor:
Immediately - to the surgeon who operated, and if it does not work - to the waiting room: after a recent surgery the stump is increasingly painful or swollen; the skin of the stump is warm, red, and painful; fluid or pus is coming from the wound. On the same day: pulsating pain or swelling in the leg or healthy arm (possible clot); coughing up blood; depressed mood or suicidal thoughts — tell your doctor, and if there is a danger that the person may harm themselves immediately, call 103. Planned: Pain in the residual limb or phantom pain that does not go away; the prosthesis fits poorly, the socket rubs; amputation is only planned — a consultation with a surgeon together with a prosthetist.
05 / DIAGNOSTICSHow to evaluate
How to evaluate
stump.
- Conversation and documents
When and at what level the amputation was done, what surgeries have already been performed, what hurts, what type of prosthesis and what is wrong with it, what you expect from the prosthesis. Bring medical records and images.
- Stump examination
The surgeon evaluates the skin and scars, painful points, whether there is enough soft tissue over the bone, and movements in the remaining joints.
- Bone images
X-rays or CT scans show the length and condition of the stump bone — this is important for osseointegration and reconstruction.
- Muscle signals
Together with the prosthetist, they assess which stump muscles can control a bionic prosthesis.
- Joint decision
The surgeon and the prosthetist decide what operation is needed and whether it is needed at all.
06 / TREATMENTWhat can be done
What can be done
after arm amputation.
Post-amputation treatment includes rehabilitation, a prosthesis, and, if needed, surgery on the stump. The VA/DoD guideline (2022) recognized that only 4 out of 18 of its recommendations for upper limb amputation rehabilitation have sufficient evidence: there is a lack of high-quality research in this field, so the plan is tailored for each individual.
01
Prosthesis and training
Receiving a prosthesis is not enough — one needs to learn to live with it.
- Type of prosthesis
- A systematic review of 31 publications found no overall advantage of any type: body-powered prostheses are more reliable, easier to learn and maintain; myoelectric ones are more aesthetic, associated with less phantom pain, and better suited for light work.
- Training
- In an Austrian survey of people after traumatic hand amputation (68 people were sent the questionnaire), 44% of respondents refused the prosthesis; most often they complained about discomfort and weight. The authors believe that training tailored to the individual and participation in the choice of prosthesis most likely help with its acceptance.
02
Surgery for the prosthesis
When the stump does not allow the prosthesis to function.
- TMR
- Nerves going to the lost hand are sewn to the motor branches of the preserved muscles of the stump. When a person "thinks" about movement, the muscle contracts, and the prosthesis sensors read the signal. In a review of 39 studies (449 patients after TMR), after surgery, prosthesis control and function improved.
- RPNI
- The end of the nerve is wrapped with a small piece of the person's own muscle. Primarily — to prevent neuroma; in studies, such muscle also provided separate signals for the prosthesis.
- Osseointegration
- The prosthesis is attached to a titanium post in the bone, without a socket. The method is relatively new: in a review of 8 studies (retrospective analyses and case series) on arm-level amputation, people with such a prosthesis had greater range of motion and performed daily activities better than with a socket. Complications: according to a review of 12 cohort studies, infections and other soft tissue problems around the post are common; in the arm, the implant loosened in 13–23% of cases, and after forearm amputation, the intramedullary rod broke in 27%. There is little data on the hand, so the authors do not make final conclusions.
03
pain
- How common
- According to a meta-analysis, 58% of people have stump pain after arm amputation, and symptomatic neuromas occur in 22%. Phantom pain, according to another meta-analysis of all amputations, is 64%, that is, about six out of ten.
- Surgery for pain
- In a review of 17 studies, TMR and RPNI reduced neuroma pain in at least 75% of patients, and phantom pain in 45–80%. Complications occurred in 13–31%, most often slow wound healing. The authors emphasize that longer randomized studies are needed.
- Randomized study
- In the first such study (28 people with chronic pain after major amputations), TMR reduced phantom pain more than standard neuroma excision; stump pain tended to improve, but without statistical confirmation.
- Without surgery
- According to a meta-analysis of 10 randomized studies, mirror therapy reduced phantom pain during the first month; long-term effects were not confirmed. Experts support it together with gradual motor imagery and using a functional prosthesis, although systematic reviews indicate that these methods are not yet more effective than placebo.
04
Psychological support
- Why is this important?
- After an amputation, depression, anxiety, and feelings of grief may appear. After a traumatic amputation, especially in military personnel, there is a higher risk of post-traumatic stress disorder. Talking about this with a doctor is part of the treatment.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Upper limb amputation at the Dr. Valikhnovskyi Institute of Surgery is performed in the direction of "Bionic Limb Prosthetics." The clinic carries out the surgical part — operations on the stump, nerves, and bone. The prosthesis itself is selected and made by a partner prosthetist; the plan is created together.
CLINIC SERVICE
Bionic limb prostheses
Preparing the stump for a modern prosthesis: less phantom pain, clearer signals, attachment to the bone.
View service
What we do for this condition
- TMR — Targeted Muscle Reinnervation — nerves that went to the hand and forearm are redirected to the preserved muscles of the stump to provide signals for a bionic hand and reduce neuroma pain and phantom pain.
- RPNI — Regenerative Peripheral Nerve Interface — the end of the nerve is wrapped with a small flap of the patient's own muscle — primarily for the prevention and treatment of neuromas.
- TMR or RPNI during amputation — if the limb cannot be preserved — prophylactically, to reduce the risk of neuromas and phantom pain.
- Excision of neuromas — a painful overgrowth of the nerve is removed, and the nerve is transferred to the muscle to reduce the risk of the neuroma forming again.
- Osseointegration — the prosthesis is attached to a titanium pin in the stump bone, without a sleeve; in one or two stages. Not suitable for everyone: the quality of the bone, the condition of the skin, and daily care of the pin exit site are important. The most common complications are infections and irritation of the soft tissues at the site where the pin exits through the skin; loosening or breakage of the implant may also occur.
- Stump reconstruction — excision of scars, closure of the bone with full tissue, if necessary — with flaps.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend a photo of the stump, medical records, and images — the doctor will preliminarily assess the situation.
- Assessment with the prosthetistExamination of the stump, pain, and muscle signals; deciding whether surgery is needed at all.
- PlanWhat surgery, when, and how to link it with the creation of a prosthesis.
- SurgeryTMR or RPNI, osseointegration or stump reconstruction.
- Healing and trainingNerves grow into muscles over months; the prosthetist adjusts the prosthesis, the person learns to control it.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Do you make prostheses yourselves?
No. The clinic performs surgical stump preparation, and the prosthesis is selected and made by a partner prosthetist; the plan is made together.
Is surgery required to wear a bionic prosthesis?
Not always. During the evaluation, the surgeon and prosthetist decide whether surgery is needed at all. TMR is considered when the stump's muscle signals are insufficient for control or cause pain.
Is it possible to perform TMR years after an amputation?
Yes, even years after an amputation. If the amputation is only being planned, TMR or RPNI can be performed during it — prophylactically.
Will phantom pain go away after surgery?
It may decrease, but not in everyone and not always completely. In a review of 17 studies, phantom pain after TMR or RPNI decreased in 45–80% of patients. More details can be found on the page about phantom pain.
Which prosthesis is better — myoelectric or body-powered?
No general advantage has been found: each has its strengths. The choice depends on your needs and is made together with a prosthetist.
Is it possible to feel touch with a bionic hand?
So far, mostly in research. According to a review, almost none of the solutions for restoring sensation in hand prostheses have reached clinical practice, although electrodes implanted near nerves partially restored sensitivity.
Do you treat civilians, not only military?
Yes, both military personnel and civilians seek help. The surgeon states the cost of the operation after an examination; the prosthesis is paid for separately to the prosthetist.
Sources
20 sources · clinical guideline, systematic reviews, meta-analyses, randomized study, and NHSshowCollapse
- Management of Upper Limb Amputation Rehabilitation: Synopsis of the 2022 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline for Acquired AmputationAmerican Journal of Physical Medicine & Rehabilitation, 2023doi:10.1097/PHM.0000000000002164 ↗
- Global Overview of Acquired Upper Limb Amputation Epidemiology: A Systematic Review of Prevalence, Incidence, Level, and EtiologyAnnals of Rehabilitation Medicine, 2025doi:10.5535/arm.250106 ↗
- The prevalence and risk factors for phantom limb pain in people with amputations: A systematic review and meta-analysisPLOS ONE, 2020doi:10.1371/journal.pone.0240431 ↗
- Prevalence of residual limb pain and neuromas after upper extremity amputation: a systematic review and meta-analysisJournal of Hand Surgery (European Volume), 2025doi:10.1177/17531934251345368 ↗
- Targeted Muscle Reinnervation Treats Neuroma and Phantom Pain in Major Limb Amputees: A Randomized Clinical TrialAnnals of Surgery, 2019doi:10.1097/SLA.0000000000003088 ↗
- Pain and Functional Outcomes following Targeted Muscle Reinnervation: A Systematic ReviewPlastic and Reconstructive Surgery, 2024doi:10.1097/PRS.0000000000010598 ↗
- Targeted muscle reinnervation and regenerative peripheral nerve interfaces for pain prophylaxis and treatment: A systematic reviewPM&R, 2023doi:10.1002/pmrj.12972 ↗
- Targeted muscle reinnervation in upper extremity amputation in military hand surgery: A systematic reviewHand Surgery and Rehabilitation, 2023doi:10.1016/j.hansur.2023.07.006 ↗
- Emerging Value of Osseointegration for Intuitive Prosthetic Control after Transhumeral Amputations: A Systematic ReviewPlastic and Reconstructive Surgery Global Open, 2024doi:10.1097/GOX.0000000000005850 ↗
- Differences in myoelectric and body-powered upper-limb prostheses: Systematic literature reviewJournal of Rehabilitation Research and Development, 2015doi:10.1682/JRRD.2014.08.0192 ↗
- Current rates of prosthetic usage in upper-limb amputees — have innovations had an impact on device acceptance?Disability and Rehabilitation, 2022doi:10.1080/09638288.2020.1866684 ↗
- Complications of bone-anchored prostheses for individuals with an extremity amputation: A systematic reviewPLOS ONE, 2018doi:10.1371/journal.pone.0201821 ↗
- A review of invasive and non-invasive sensory feedback in upper limb prosthesesExpert Review of Medical Devices, 2017doi:10.1080/17434440.2017.1332989 ↗
- Effectiveness of Mirror Therapy for Phantom Limb Pain: A Systematic Review and Meta-analysisArchives of Physical Medicine and Rehabilitation, 2022doi:10.1016/j.apmr.2021.07.810 ↗
- Treatment Recommendations for Phantom Limb Pain in People with Amputations: An Expert Consensus Delphi StudyPM&R, 2021doi:10.1002/pmrj.12556 ↗
- AmputationNHS, 2023nhs.uk/tests-and-treatments/amputation ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
- Pulmonary embolismNHS, 2026nhs.uk/conditions/pulmonary-embolism ↗
- Deep vein thrombosis (DVT)NHS, 2026nhs.uk/conditions/deep-vein-thrombosis-dvt ↗
The figures on the page are from these sources.
Does the stump hurt or
are you preparing for a prosthesis?
Send a photo of the stump, medical records, and images. The doctor together with the prosthetist will tell whether surgery is needed and which type.