Upper Extremity Amputations Flashcards
(31 cards)
Etiology of upper limb loss
- Disease; peripheral vascular disease, diabetes, infection
- Injury; MVA, gunshots, crush injuries (leading cause of upper limb amputation)
- Congenital; amniotic band syndrome
Most common trauma related upper limb amputation
Digital loss
Levels of UE amputations
Proximal
- inter scapular thoracic
- shoulder disarticulation
- trans-humeral (short and long)
- elbow disarticulation
- trans-radial (short and long)
- wrist disarticulation
- trans-metacarpal
- digit
Distal
Post-surgical factors
- skin
- sensation; changes, hyper/hypo
-neuroma - phantom limb and phantom sensations
- bone
- wound healing
Factors influencing candidacy for prosthetic
- desire for prosthesis
- age
- medical status
- amputation level
- skin coverage and condition; high infection risk
- cognitive status; for prosthetic limb care
Passive prostheses
- mostly cosmetic
- may allow some degree of function; carrying or holding (limited)
Pros: cosmesis, self-image, light-weight
Cons: limited functional use
Uncanny valley
More real prosthetic looks, less desirable, psychologic component
Body-powered prostheses
- prosthetic sock
- socket
- harness and control system
- terminal device; hook or hand
- wrist unit
- elbow units
- shoulder units
Voluntary open
Resting position is closed have to voluntary open
Voluntary close
Resting position is opened have to voluntary close
Electric power/myoelectric prostheses
- muscle surface electricity controls prosthetic hand function
- minimal physical effort for operation
- hybrid prostheses
Advantages for electric powdered prostheses
- cosmesis; looks cool
- increased grip force
- little to no harnessing
- overhead use; not using body mechanics to alter tension
- minimal effort to control
Disadvantages of electric powered
- costly
- maintenance and repair frequency
- fragile glove and replacement frequency
- lack of sensory feedback
- slower hand response to muscle activation (delay)
- increased weight
Candidates for electric powered prostheses
- adequate strength and muscle contraction
- capability for stronger muscle signals and contraction
- capability for contraction difference between muscles
- age, medical status, sensation, skin, bone integrity, cognitive status
Pre-prosthetic evaluation
- occupational profile
- functional assessment
- residual limb assessment
- wound care
- skin
- sensory testing
- ROM
- strength
- circumference
Pre-prosthetic tx
- body image, self image
- ADLs
- wound healing
- desensitization
- wrapping
- circumference
- skin hygiene
- UE ROM, strength, endurance
Prosthetic program
- body image and self image
- residual limb and prosthetic sock hygiene
- prosthesis terminology and function
- prosthesis care
- donning/doffing
- wearing schedule
- control training
- use training
- functional training
Trans-radial prosthesis
- elbow flexion ROM
- pronation/supination ROM w/ prosthesis on
- terminal device function with elbow flexion
Trans-humeral and shoulder prosthesis
- shoulder ROM w/ prosthesis on and elbow locked and unlocked
- terminal device functioning at different degrees of ROM
- arm swing while ambulating
Coat method for donning/doffing
Harness first then device
Sweater method donning/doffing
Device first then harness
Control training for trans-radial
- terminal device control
- pronation/supination
- exchanging terminal devices
Control training for trans-humeral
- shoulder rotation
- elbow flexion/extension
- elbow locking
- terminal device control
Control training for shoulder disarticulation
- chest harness to secure
- chin nudge control to operate elbow unit
- friction held shoulder unit
