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Upper Ext 2 Flashcards

1
Q

Partial Hand Amputation

A

Any AMPUTATION DISTAL TO THE WRIST

LEAST INVOLVED of the UE amputations

Can be as minor as losing DISTAL PART OF PHALANGE major as LOSING ALL THE METATARSALS

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2
Q

Wrist Disarticulation

A

TRANSECTION THROUGH WRIST

Carpals are disconnected from radius and ulna

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3
Q

Trans-Radial (Below Elbow)

A

Amputation that occurs BELOW ELBOW JOINT and PROXIMAL TO THE WRIST

Can be classified further as LONG, MEDIUM, SHORT, VERY SHORT

Ideally beneficial for trans-radial to be LONG ENOUGH that it is at least PAST THE BICIPITAL TUBEROSITY, SHORT ENOUGH to allow approximately 3.5 cm for wrist unit

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4
Q

Elbow Disarticulations

A

Amputations that TRANSECT THE ELBOW JOINT

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5
Q

Trans-humeral (above elbow)

A

Amputations that occur THROUGH THE HUMERUS

STANDARD LENGTH for trans-humeral limb is 50-90% of original length

Prosthetic considerations include SUSPENSION and ROTATION control

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6
Q

Shoulder disarticulations

A

Amputations of the COMPLETE HUMERUS at the Gleno humeral joint and everything distal

Commonly due to TRAUMA AND AVULSION

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7
Q

Interscapulothoracic Disarticulation (Forequarter)

A

Amputations are commonly performed due to OSTEOSARCOMA OF SHOULDER GIRDLE

Amputation removes the SHOULDER GIRDLE INCLUDING THE SCAPULA and ALL OR PART OF THE CLAVICLE

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8
Q

Why Disarticulations?

A

NOT AS VALUABLE in UE as LE

DISTAL END WEIGHT BEARING NOT AS ADVANTAGEOUS

However, SPECIAL CONSIDERATIONS for children due to GROWTH

Want to PREVENT OVERGROWTH in a transected bone

Disarticulations are ARGUABLY LESS COSMETIC

ADVANTAGES include SUSPENSION and RETENTION of PHYSIOLOGIC POSITION of the TERMINAL DEVICE IN SPACE

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9
Q

Amelia

A

COMPLETE ABSENCE OF LIMB

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10
Q

Phocomelia

A

VERY SHORT LIMB, usually terminating with a FUNCTIONAL HAND

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11
Q

Terminal Transverse Hemimelia Above-Elbow

A

Congenital ABOVE ELBOW AMPUTATION

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12
Q

Terminal Transverse Hemimelia Below-Elbow

A

Congential BELOW ELBOW AMPUTATION

MOST COMMON OF CONGENITAL LIMB DEFICIENCIES

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13
Q

Acheiria

A

ABSENCE OF HAND

Congenital wrist disarticulation

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14
Q

Longitudinal Deficiency (Radial or Ulnar) Hemimelia

A

RADIAL is far more common

These usually present with a FUNCTIONAL HAND

Main issue is RADIAL/ULNAR DEVIATION

RARELY REQUIRE PROSTHETIC CARE

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15
Q

Milbrant Device

A

Originally developed in British Columbia for lumberjacks

Used to REPLACE MISSING DIGITS 2-5

Device is traditionally made of leather with buckle closure for durability

FINGER BAR has HIGH FRICTION material

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16
Q

Opposition post

A

SMALLER IN SIZE than the Milbrant

Used for LIGHTER TASKS and is better suited for FINE DETAIL

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17
Q

Spatula

A

LIGHT DUTY device used when there are NO FINGERS PRESENT

WRIST MOTION in order to use device

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18
Q

Functional loss

A

THUMB represents GREAT PORTION OF FUNCTION of our hands

If AMPUTATED AT MC joint, there is 40% loss in hand function, 100% loss of thumb function

If ALL PHALANGES ARE AMPUTATED, it is considered a 100% loss of the hand

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19
Q

Conventional Prostheses

A

PASSIVE

BODY POWERED

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20
Q

Passive prostheses

A

Have some MANUAL OPPOSITION functions

Also provide “COSMETIC” coverage of the residuum

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21
Q

Body powered prostheses

A

Usually controlled by using CABLE SYSTEM

Quite DURABLE, have BETTER SENSORY FEEDBACK

These types of prosthesis are NOT AS COSMETICALLY PLEASING as externally powered controlled type

REQUIRE LARGE ROM to control function of prostheses

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22
Q

Trans-radial Body-Powered Prosthesis PARTS

A

Includes

  • Single control harness system
  • Control cable system
  • Triceps Cuff
  • Elbow Hinges
  • Laminated Socket
  • Interface
  • Wrist Unit
  • Terminal Device
23
Q

Grip Types (8)

A
  1. Key
  2. Chuck (3 point)
  3. Span (C in web space)
  4. Hook (carry suitcase handle)
  5. Power (grab rod)
  6. Disc (holding door knob)
  7. Flat hand push (push wall)
  8. Finger push
24
Q

UE Statistics

A

50 000/yr in US

Ration UE to LE is 1:4

MOST COMMON is PARTIAL HAND AMPUTATION with loss of 1 or more fingers

WRIST HAND AMPUTATIONS make up 10% of upper limb population

TRANRADIAL AMPUTATIONS make up 60% of total wrist and hand amputations

70% of all persons with upper limb amputations have amputations DISTAL TO ELBOW

25
Trans Radial Length Classification
LONG- longer than 2/3 MED- 2/3 to 1/3 SHORT- 1/3 or shorter PRONATION/SUPINATION decreases with decreasing length
26
Wrist Disarticulation
Characterized by OVAL DISTAL END DISTAL JOINT retained therefore GREATER ROM in PRONATION/SUPINATION
27
Laminated Socket Types (5)
- SUPRACONDYLAR (Northwestern) - 3/4 Socket - MUENSTER Socket (NARROW A-P) - BASIC Socket - SCREWDRIVER Socket
28
Northwestern (SUPRACONDYLAR)
Developed at Northwestern University in Chicago SELF SUSPENDING, presses medially and laterally proximal to epicondyles Has LOWER ANTERIOR PROXIMAL TRIMLINE than Muenster to allow for more Elbow Flexion
29
3/4 Socket
Developed at Hugh Macmillan Centre in Toronto Similar to Northwestern, except there is POSTERIOR OPENING OVER OLECRANON 4 "QUADRANTS", quadrant around olecranon didn't serve a function, quadrant was cut out, hence 3/4 socket name Result is socket that is LESS CONSTRICTING, ALLOWS MORE AIRFLOW which is beneficial in myoelectric sockets where wicking socks cannot be worn ELBOW ROM and COSMESIS is also improved with cut out
30
Muenster Socket
Developed University of Muenster SELF SUSPENDING socket NARROW A-P, sometimes referred to as A-P Socket ANTERIOR PROXIMAL TRIMLINE is generally HIGHER and ELBOW FLEXION can be LIMITED by tissue bulging in the cubital area during flexion Socket is BENEFICIAL FOR SHORT TRANSRADIAL Disadvantages, are LIMITED FLEXION capabilities, DIFFICULTY DONNING
31
Basic Socket
Trimlines are DISTAL TO EPICONDYLES AND OLECRANON Can be SUSPENDED using DIFFERENT types of METHODS TRICEPS CUFF and HARNESS to attach the HINGES and the socket Using a LINER WITH A PIN at the distal end SUCTION OR NEGATIVE PRESSURE using a valve and sleeve ca
32
Screwdriver Socket
DESIGN is used for LONG RESIDUUM (at least 60% of the remaining forearm) DISTAL 1/3 OF SOCKET IS FLATTENED in the SAGITTAL PLANE to stabilize the radius and ulna to be ABLE TO PRONATE/SUPINATE the prosthesis TRIMLINE is typically CUT BELOW EPICONDYLES AND OLECRANON
33
Interface Options
SOCKS SKIN FIT SILICONE LINER
34
Wrist units
DEPENDENT ON LENGTH of remaining limb (BUILD HEIGHT) Very long limbs need specialized wrist units Options are - QUICK DISCONNECT (QD) - FRICTION - Flexion/Radio-ulnar deviation (OMNI) - LOCKING
35
Bilateral considerations for Wrist Units
FLEXION UNITS ARE IMPORTANT FOR GETTING TO MIDLINE Aids with ADLs (Activities of Daily Living), buttoning shirts etc.
36
Quick Disconnect Wrists PROs
EASY TO SWAP terminal devices LOCKING OPTION is available Gives more FUNCTION
37
Quick Disconnect Wrists CONs
HEAVIER than friction wrists MORE MECHANICAL PARTS MORE COSTLY LONGER BUILD HEIGHT NEEDED
38
Friction Wrists
LOWER BUILD HEIGHT than most QD CAN BE SHAPED TO OVAL SHAPE OF DISTAL FOREARM for greater cosmesis ADJUSTABLE TERMINAL DEVICE PRONATION/SUPINATION with washers or set screws
39
Flexion Wrist Unit
FLEXION WRIST can only provide flexion and is for conventional only OMNI wrist has ROM in all planes, can be used for conventional or myo
40
Terminal Devices
PASSIVE OR ACTIVE
41
Passive Terminal Devices
MOST COMMONLY PRESCRIBED passive terminal device is passive hand Can be for STATIC GRASP, cosmesis (social acceptance) COSMETIC - hands, off the shelf glove, silicone finished OPERATED BY CONTRALATERAL HAND, environment, or does not move TASK SPECIFIC / ACTIVITY BASED device (bicycle, hockey, baseball etc.). SPORTS, SPECIALIZED ACTIVITIES
42
Active Devices
Can be either HOOKS OR HANDS Provide 3 POINT CHUCK ACTION Most hooks provide the equivalent of active lateral pinch grip ACTIVE PROSTHETIC HAND is more COSMETICALLY pleasing but usually HEAVIER AND BULKIER than a hook Can be VOLUNTARILY OPENING, VOLUNTARILY CLOSING
43
Voluntary Opening (VO)
Terminal device CLOSED AT REST Device can be OPENED BY PROTRACTION of the scapula or FLEXION of the shoulder RUBBER BANDS on hooks or internal springs/cables in hands offer RESISTIVE FORCE FOR OPENING RELAXING shoulder muscles allows terminal device to CLOSE ONE RUBBER BAND provides 1 POUND of pinch force In order to simulate AVERAGE ADULT PINCH force of 15-20 pounds addition rubber bands added
44
Voluntary Closing (VC)
Terminal Device is OPEN AT REST VC device TYPICALLY HEAVIER AND LESS DURABLE than VO device In order to MAINTAIN CLOSURE of the device to grasp on to the desired object, ACTIVE MUSCLE CONTRACTION REQUIRED Amputee can get some SENSORY FEEDBACK with this type of terminal device CLOSING PRESSURE can be as high as 20-25 lbs
45
Types of Hooks
CANTED LYRE Many different styles for different activities Can be either VO or VC Objects can be visualized better due to open design Tougher than hands
46
Canted Hooks
SIDE approach OBJECTS MORE VISIBLE when grasping OBJECT is ROLLED into its GRASP CANNOT PICK UP SMALL OBJECTS like pins easily
47
Lyre Shaped Hooks
STRAIGHT Approach More applicable to bottle or cylindrical shapes OBJECT is PINCHED Can PICK UP SMALL OBJECTS EASIER than canted
48
Terminal Device Hands
Can be both VO or VC ACTIVE OR PASSIVE POWERED OR PASSIVE operation FUNCTION OR AESTHETICS
49
Location of Northwestern Ring
At HEIGHT OF C7 NO MORE than 1 '' towards SOUND SIDE
50
Quick Disconnect Wrist PROS
Easy to SWAP terminal devices More FUNCTION LOCKING option
51
Quick Disconnect Wrist CONS
Heavier More mechanical parts More costly Longer build height required
52
Friction Wrists
LIGHTER LOWER BUILD HEIGHT Can be OVAL for COSMESIS ADJUSTABLE RESISTANCE to pronation/supination
53
Flexion Radio/Ulnar Deviation Wrist
LOCKABLE at different ANGLES WEIGHT and BUILD HEIGHT increase More MECHANICAL parts Can be used to get TD CLOSER TO MIDLINE
54
Transhumeral length vs control
Condyles remain, primary control is from humerus Distal to deltoid insertion, primary control is from humerus assisted by shoulder girdle Proximal to deltoid insertion, primary control is form the shoulder girdle assisted by the humerus

Prosthetic Study (10 decks)

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