What is the Limb Optimization Clinic?

The Limb Optimization Clinic (LOC) is a specialized program that focuses on restoring function and relieving pain in patients who have experienced limb loss, nerve injury, upper limb amputation, or neurological impairment.

The clinic is staffed by fellowship-trained orthopedic surgeons and plastic surgeons, as well as experienced occupational therapists, all working together to create customized treatment plans that include both non-surgical therapy and advanced surgical options. We also bring together other specialists, including prosthetists, occupational therapists, pain management doctors, psychiatrists, psychologists, case managers, and social workers, to provide a comprehensive service tailored to meet all our patients’ needs.

At the LOC, our goal is simple: to help patients improve daily living, enhance comfort with artificial limb prostheses, and regain as much function as possible—whether you’re weeks or years out from injury.

Comprehensive Support for All Levels of Limb Amputation

Amputation may involve different levels of the arm, and each level comes with its own challenges and opportunities for rehabilitation. The Limb Optimization Clinic provides support for all types of limb amputations, including:

• Shoulder amputation
• Above-elbow amputation
• Below-elbow amputation
• Wrist disarticulation
• Hand and partial hand amputation
• Finger amputation
• Lower extremity amputation

Each level of amputation can affect how a patient uses an artificial limb, how wound healing is managed, and what types of therapy or surgery may be appropriate.

Optimizing Function for Amputees

An amputation is a life-changing event. We at Georgia Hand, Shoulder & Elbow want you to know that there are both non-surgical and surgical treatments that can help optimize your function after amputation.

Amputation

Amputation refers to the surgical removal of part or all of a limb due to trauma, infection, vascular disease, or cancer. It can involve any part of the body, but upper limb amputation (such as of the hand, wrist, forearm, or arm) and knee amputation (or lower limb) are common in certain medical cases. After surgery, patients may experience physical and emotional challenges, including residual limb pain, phantom limb sensations, and adjustment to a new way of life.

Treatment after an amputation focuses on amputation rehabilitation, which includes physical therapy, pain management, and training with an artificial limb or prosthetic device. Therapy helps improve strength and function, prevent contractures, and reduce swelling to support wound healing.

Patients work closely with a physical therapist to regain independence in daily living and learn how to use artificial limb prostheses effectively. In some cases, surgical techniques like targeted muscle reinnervation or regenerative peripheral nerve interfaces may be used to address nerve-related pain or improve prosthetic control.

Residual Limb Pain

Residual limb pain is pain in the remaining portion of your limb after an amputation. This pain often originates from a symptomatic neuroma, which is a disorganized collection of nerve fibers that forms after a nerve is cut. It is important to know that there are both surgical and non-surgical treatment options for painful neuromas and residual limb pain.

It is not normal to have pain after you have healed from an amputation, and you don’t have to simply live with the pain. Non-surgical options offered by our Therapy Department include nerve desensitization techniques, mirror therapy, and many others. Surgical treatments such as Targeted Muscle Reinnervation (TMR) and Regenerative Peripheral Nerve Interfaces (RPNI) can also be helpful in properly selected patients.

Phantom Limb Pain

Phantom limb pain is the perception of pain or other sensations in the portion of an extremity that has been amputated. It is common among people who have had amputations. Scientists still struggle to fully explain the cause of phantom limb pain. Nonetheless, many treatments have been developed to lessen the burden of phantom limb pain.

Our surgeons and therapists will work with you to develop an individualized treatment plan, which may include modalities such as mirror therapy, massage, biofeedback, and, in some cases, surgery. There are newer surgical techniques called Targeted Muscle Reinnervation (TMR) and Regenerative Peripheral Nerve Interfaces (RPNI), which have shown promise in the treatment of phantom limb pain.

Optimizing Arm and Hand Function for Patients with Brain, Spinal Cord, and Brachial Plexus Injury

People who have sustained a brain, spinal cord, or brachial plexus injury often have decreased function of their arms and hands. We at Georgia Hand are passionate about helping you maximize your function and independence after a brain, spinal cord, or brachial plexus injury.

Spasticity and Contracture

Spasticity is a common upper extremity problem for patients who have suffered a brain injury. Spasticity causes tightness or stiffness of muscles which can make it difficult to use your arm or hand. Common forms of brain injury that can lead to spasticity are stroke (CVA), traumatic brain injury (TBI), and cerebral palsy. When spasticity is severe or remains untreated, it can lead to joint contractures.

Many people are unaware that there are treatment options for both spasticity and joint contractures, which can greatly improve function and quality of life. These include physical therapy and occupational therapy, Botox injections, and surgical treatments. At Georgia Hand, Shoulder & Elbow, we will develop a personalized plan to treat you or your loved one’s spasticity or contracture.

Spinal Cord Injury and Quadriplegia

Injury to the spinal cord can cause decreased function in the arms and hands. Many people are unaware that there are several ways to optimize hand and arm function for people with spinal cord injuries and quadriplegia. These include non-surgical treatments such as stretching, muscle strengthening, and custom-made splints.

There are also surgical options such as Nerve Transfers and Tendon Transfers, which can dramatically improve function. We at Georgia Hand know that life can be challenging after a spinal cord injury. We are here to help optimize your function.

Brachial Plexus Injury

The brachial plexus is a network of nerves located in your neck and armpit (axilla). This is where nerves (cervical roots) exiting your spinal cord combine, crisscross, and ultimately branch into the smaller nerves that travel down your arm. People can occasionally sustain injuries to this network of nerves, leading to decreased function of the arm or hand.

There are also rare tumors that can compress the brachial plexus and cause problems as well. It is important for people to know that there are treatment options for brachial plexus injuries. These include non-surgical options like desensitization for pain control and specialized splints and braces.

There are also surgical treatments that can be helpful in carefully selected patients. These include Nerve Repair or Grafting, Nerve Transfers, Tendon Transfers, and Scar Release (Neurolysis) from around the brachial plexus.

Stroke

A stroke occurs when blood flow to a part of the brain is interrupted, either by a blockage (ischemic stroke) or bleeding (hemorrhagic stroke). This interruption can lead to brain damage, resulting in weakness, paralysis, or loss of coordination—often on one side of the body. Many stroke survivors experience spasticity, stiffness, or impaired use of the arms and hands, which can limit independence in daily activities.

Treatment focuses on improving function and managing complications like spasticity and contractures. Options may include physical and occupational therapy, stretching routines, custom splints, and Botox injections to reduce muscle tightness. In select cases, surgical procedures such as tendon lengthening or nerve and tendon transfers can restore hand and arm movement.

Traumatic Brain Injury

Traumatic Brain Injury (TBI) results from a sudden impact or jolt to the head, disrupting normal brain function. Depending on the severity, TBI can cause motor deficits, poor coordination, cognitive changes, and upper limb dysfunction. Many patients with TBI experience spasticity, muscle imbalance, or joint contractures in the arms.

Treatment includes a combination of rehabilitation and medical management. Therapy helps retrain movement patterns and build strength, while stretching maintains joint mobility. Spasticity may be treated with medications, Botox, or surgical options such as nerve releases or tendon transfers to restore more useful motion in the upper limb.

Cerebral Palsy

Cerebral Palsy is a group of neurological disorders that affect movement, muscle tone, and posture, usually caused by brain damage occurring before or during birth. Children and adults with CP may have stiff or floppy muscles, involuntary movements, and difficulty with fine motor tasks. The arms and hands are commonly affected in spastic types of CP.

Treatment is tailored to the individual’s needs and may include occupational therapy, stretching, custom bracing, and assistive devices. Spastic muscles can be treated with Botox injections or surgical procedures such as tendon lengthening or selective dorsal rhizotomy. In some cases, tendon or nerve transfers can improve functional hand use.

Peripheral Nerve Injury

Peripheral nerve injury involves damage to the nerves outside the brain and spinal cord, often due to trauma, compression, or stretching. This can lead to weakness, numbness, pain, or complete loss of movement in parts of the arm or hand, depending on which nerves are affected.

Treatment depends on the cause and severity of the injury. Mild injuries may heal with rest, therapy, and splinting, while more serious cases could require surgical intervention. Nerve repair, grafting, or nerve transfers are common surgical options. Therapy plays a key role in recovery by preserving range of motion and rebuilding strength.

Radiation Neuritis

Radiation neuritis is nerve damage caused by exposure to radiation, often as part of cancer treatment. This condition typically develops gradually and can affect the brachial plexus or other peripheral nerves, leading to pain, numbness, weakness, or functional loss in the upper limb.

Treatment includes pain management, physical therapy, and supportive care to maintain limb function. In some cases, surgical interventions such as neurolysis (removal of scar tissue around nerves) or nerve transfers may be considered to restore movement or relieve compression. Early diagnosis and therapy can help slow progression and improve quality of life.

Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that usually develops after an injury or surgery. It involves prolonged pain, swelling, changes in skin color or temperature, and sensitivity in the affected limb. Though the exact cause isn’t fully understood, CRPS is believed to involve abnormal nerve signaling.

Treatment is often multi-disciplinary. It may include physical therapy to prevent stiffness, desensitization techniques, mirror therapy, and medications for nerve pain. In resistant cases, sympathetic nerve blocks or spinal cord stimulation might be explored. Early treatment is key to preventing long-term disability and improving arm function.

Other Neurological Conditions

Conditions like Guillain-Barré Syndrome, Parsonage-Turner Syndrome, and Transverse or Acute Flaccid Myelitis can cause sudden and severe weakness, paralysis, or sensory loss in the arms due to inflammation or immune system attacks on nerves or the spinal cord. These are rare but can lead to long-term upper limb dysfunction.

Treatment focuses on restoring movement and managing residual deficits. Therapy is essential to maintain flexibility and build strength. In some cases, nerve or tendon transfers may be considered to regain specific movements. Pain management and custom splinting also play a role in preserving function during recovery.

Treatments Provided at Our Limb Optimization Clinic

The Limb Optimization Clinic offers comprehensive amputation rehabilitation and neurological recovery treatments. Here’s a breakdown of the main interventions:

• Physical and Occupational Therapy: Guided by a physical or occupational therapist, therapy focuses on strength, stretching, fine motor control, blood flow stimulation, and adapting to an artificial limb.
• Mirror Therapy: Helps retrain the brain and may reduce phantom limb pain using visual feedback.
• Desensitization Techniques: Massage, vibration, and other tactile stimuli can reduce pain sensitivity in the residual limb.
• Targeted Muscle Reinnervation (TMR): Redirects nerves to new muscle targets to reduce neuroma pain and improve control of prosthetic devices.
• Regenerative Peripheral Nerve Interfaces (RPNI): Uses small muscle grafts to prevent neuromas and enable better artificial limb use.
• Tendon Transfers: Reassigns muscle function to improve motion after spinal cord injury or nerve damage.
• Nerve Transfers: Helps restore movement and sensation in cases of brachial plexus or peripheral nerve injury.
• Botox Injections: Temporarily reduces spasticity to allow better movement and prevent contracture.
• Custom Splinting: Aids in wound healing, positioning, and comfort—especially important for those with dry skin or sensitive residual limbs.
• Neurolysis: Surgically removes scar tissue that may be compressing nerves and causing pain.

Restore Function and Relieve Pain

Whether you’re recovering from an upper limb amputation, dealing with pain from a nerve injury, or struggling with mobility, the Limb Optimization Clinic at Georgia Hand, Shoulder & Elbow is here to help. We offer specialized care in Marietta and Atlanta, GA, to support your recovery every step of the way—from initial evaluation to advanced surgical solutions.

Take the next step. Contact us today to schedule your appointment and explore the best options for restoring movement, easing pain, and improving your quality of life!