UE limb loss - lecture

reasons for UE amputation

most common: trauma, tumor, vascular compromise

less common: infection, congenital, disease progression

types of UE amputations

- hand, partial hand and digits

- wrist disarticulation

- trans-radial

- elbow disarticulation

- trans-humeral

- shoulder disarticulation

- fore quarter amputation

hand, partial hand, and digits amputations

- trans-phalangeal

- trans-metacarpal

- trans-carpal

*most commonly seen UE amputations

trans-radial amputation

- elbow flexors and extensors preserved

- excellent prosthetic potential

elbow disarticulation

- humeral leverage preserved

- good suspension

Trans-humeral amputation

- limited elbow control preserved

- complex prosthetic

shoulder disarticulation

significant functional challenge

what is the "golden period" of fitting for an UE prosthesis?

30 days (93% success rate)

types of UE prosthetics

- passive functional/cosmetic (low function and effort)

- body-powered/conventional (high function and effort)

- myoelectric/external power (high function, low effort)

- hybrid (highest function, moderate effort)

advantages of passive functional/cosmetic

- lightweight, simple

- little maintenance

- inexpensive

- improved appearance

disadvantages of passive functional/cosmetic

- limited grasping function

- decreased durability

- unreal expectations for cosmesis

reasons people choose to not use a prosthesis

- poor initial fitting (discomfort, poor socket fit, early frustration)

- limited benefit (difficulty with fine motor, prosthetic isn't better than compensatory strategies)

- insufficient education and training (lack of training, limited follow-up with rehab)

- cost and maintenance (device replacement, insurance limitations)

- cosmetic concerns (unnatural appearance, personal preferences)

rehab goals after amputation

- skin integrity

- ROM and contracture prevention (positioning, stretch)

- strength and endurance

- function and future function

- prosthetic readiness

- participation and QoL

complications in UE limb loss

- RLP (contracture; prosthetic acceptance)

- phantom sensation (body asymmetry; PTSD)

- phantom pain (overuse syndromes; body image concerns)

- neuroma

- HO

- skin breakdown

- edema

phantom pain/sensation is (more/less) likely to occur with a prosthetic

less

levels of partial hand amputation

1. transphalangeal: thumb spared

2. thenar partial or complete

3. transmetacarpal, distal: thumb spared or involved

4. transmetacarpal, proximal: thumb spared of involved

thumb gives --% of function of the hand

60

at the least, how many fingers do they preserve during partial hand amputations?

2 - able to oppose each other, will allow some prehension (the abilility to approach, grasp, and release objects with the hand)

during a partial hand amputations, salvage of a third digit allows for

more stable terminal pinch, improving precision motions

what do surgeons want to eliminate during partial hand amputations?

eliminate a gap between adjacent fingers (objects fall through the hand)

most common mid-level amputation surgery

trans-radial

osseointegration is (more/less) common in UE

more (also heals better than LE)

terminal devices: voluntary opening

- opens when user exerts tension on the cable

- when tension is released, spring/rubber band closes the hand

- pinch force can be adjusted by spring/rubber band

*reliable and durable but constant spring force

terminal devices: voluntary closing

- closes when user exerts tension on the cable

- pinch force is determined by wearer (strong/light)

**variable grip force but greater training needed

prosthetic components

- harness

- socket

- terminal device / manipulators

a harness can add -- lbs

8-10

prosthetic hand vs split hook

- prosthetic hand: heavier in weight, more difficult to see objects being grasped, more complex mechanically, cannot get into pockets, less versatile as a tool, better cosmesis

- split hook: lighter in weight, easier to see objects being grasped, simpler mechanically, will fit into pockets, versatile as a tool, not cosmetic

for a body powered/conventional prosthesis, the components of it are operated by

a harness system

- elbow

- terminal device (hand) (VO or VC)

for a body powered/conventional prosthesis, the harness system is controlled by gross body movement:

- scap abduction

- chest expansion

- shoulder depression

for a body powered/conventional prosthesis: single-control harness operates

the terminal device (hand)

for a body powered/conventional prosthesis: double-control harness

- 2 control cables are used

- activation of terminal device and elbow/forearm flexion

- elbow joint lock/release

shoulder disarticulation - how do they control:

- elbow flexion

- terminal device

- elbow lock

- elbow flexion & terminal device: biscapular abduction & lats activation

- elbow lock: scapular elevation

transhumeral amputation - how do they control:

- elbow flexion

- terminal device

- elbow lock

- elbow flexion & terminal device: biscapular abduction and humeral flexion

- elbow lock: shoulder depression and humeral abduction & extension

transradial amputation - how do they control:

- elbow flexion

- terminal device

- elbow lock

- elbow flexion & lock: intact

- terminal device: biscapular abduction and humeral flexion

which is less expensive: body powered/conventional, myoelectric/external power, or hybrid

body powered/conventional

which has greater grip force: body powered/conventional, myoelectric/external power, or hybrid

myoelectric/external power and hybrid

which has reduced need for harness: body powered/conventional, myoelectric/external power, or hybrid

myoelectric/external power and hybrid

which has increased weight: body powered/conventional, myoelectric/external power, or hybrid

myoelectric/external power

which may have possible overuse/nerve entrapment: body powered/conventional, myoelectric/external power, or hybrid

body powered/conventional

targeted muscle reinnervation

- nerve transfer/rerouting

- decreases neuroma pain and amputation pain

- assists with myoelectric prosthetic control

targeted sensory reinnervation (TSR)

when combined with a special prosthetic device, the amputee can recieve sensory feedback from the prosthesis which can improve balance and gait