U L prosthesis 2

Upper Limb Prosthesis Overview

  • Presenter: Dr. Ramy Salama, MSc. PhD

Definition

  • A prosthesis is an artificial replacement for any or all parts of the lower or upper extremities.

  • It aims to restore as much function or appearance as possible to a missing limb or body part.

Role of Physical Therapist

  • Preoperative Education: Educates patients about the rehabilitation process and instruction in single limb mobility.

  • Pre-Prosthetic Rehabilitation: Designs and manages a program focused on mobility and preparation for prosthetic training.

Patient Evaluation and Training

  • Readiness Assessment: Evaluates the patient's readiness for prosthetic fitting and provides recommendations.

  • Prosthetic Training Program: Manages a program focusing on functional ambulation and prosthetic management.

  • Monitoring: Keeps track of the remaining extremity's condition, especially for patients with PVD, neuropathy, or diabetes.

Reasons for Prosthesis Use

  1. Amputation Due to:

    • Trauma

    • Complications from diabetes

    • Peripheral vascular disease

    • Tumors or cancer (e.g., osteosarcoma of the humerus)

  2. Congenital Malformations:

    • Dysmelia: Congenital limb deficiency.

    • Phocomelia: Shortened upper limb.

    • Amelia: Absence of upper limb.

Purposes of Prosthesis

  1. To provide amputees with an opportunity to perform functional tasks, especially ambulation.

  2. Prostheses can also be used for activities like swimming, cycling, golfing, and climbing.

  3. Additionally, they serve cosmetic purposes.

Prosthetic Considerations

  • Amputation Levels: Determines the type and fit of the prosthesis.

  • Expected Function: Understanding what the prosthesis needs to accomplish.

  • Cognitive Function: The mental capacity of the patient to use the prosthesis effectively.

  • Patient's Vocation and Hobbies: Consideration of lifestyle in prosthesis design.

  • Cosmetic Importance: How the prosthesis looks matters.

  • Financial Resources: Affordability of the prosthesis types.

Characteristics of a Successful Prosthesis

  1. Comfortable to wear.

  2. Easy to put on and remove.

  3. Lightweight.

  4. Durable and cosmetically pleasing.

  5. Mechanically functional with reasonable maintenance.

  6. Individual motivation is critical to ensure the prosthesis is worn.

Problems in Prosthesis Use

  1. Poor fitting can cause unequal weight distribution, leading to stress on unaffected legs or stumps.

    • May result in pain, skin issues, and potential infections.

  2. Using a prosthesis often requires additional energy.

  3. Daily checks of the stump for issues like redness, blisters, or swelling are necessary.

  4. Adjustments to the prosthesis may be required to achieve a proper fit.

Types of Prostheses

  1. Temporary (Preparatory) Prosthesis:

    • Fitted while the residual limb matures, allowing early prosthetic training.

    • Better final fit is achievable as the preparatory socket can mold the residual limb shape.

    • Provides a trial period for functionality.

  2. Definitive Prosthesis:

    • Prescribed once the limb has stabilized, ensuring a long-lasting fit.

    • Not permanent and have an average lifespan of 3-5 years.

Etiology of Upper Limb Amputations

  • Causes include traumatic injury, tumors (such as sarcomas), or congenital deformities like amelia and phocomelia in individuals under 15.

Levels of Amputation

  1. Partial Hand or Transcarpal Levels: Most distal, affecting fingers.

  2. Wrist Disarticulation: Separation of carpal bones from radius and ulna.

  3. Transradial Amputations: Amputation within the radius and ulna.

  4. Elbow Disarticulation: Removing radius and ulna but preserving the humerus.

  5. Transhumeral Amputations: Leaving over 30% of the humeral length.

  6. Shoulder Disarticulations: Less than 30% of the proximal humerus remains.

  7. Forequarter Amputations: Involves resection of the clavicle, impacting the scapula.

Functional Impact of Trans-Radial Amputations

  • The length of the residual limb is crucial for elbow function.

  • Extremely short residual limbs may hinder anatomical transverse motion, compromising functional forearm rotation.

  • Prosthesis selection is tailored to meet specific needs of the amputee.