WK1: UL Amputation Surgery, Evaluation, and Anatomy Flashcards
1
Q
WD and TR Surgery
Objectives
A
- Maximize precise function
- provide a good cosmetic result
2
Q
WD and TR Surgery
Other considerations
A
- patient and family participation in decisions
- coordinated rehabilitation
- Early consultation with prosthetist and early prosthesis fitting
3
Q
Skeletal Considerations
WD and TR Surgical Techniques
A
- Preserve as much bone as possible
- consider all options for soft tissue envelope
- styloids (WD) may be contoured if prominent
- dictates leverage
4
Q
Myodesis
WD and TR Surgical Techniques
A
- preferred method
- cut muscles/tendons are sutured eto bone
- physiological tension
- preserves muscle function for potential myoelectric control
5
Q
Myoplasty
WD and TR Surgical Techniques
A
- provides soft tissue loading
- attachment of agnosit to antagonist muscles
- secondary to myodesis which has greater stability
- may be performed for distal end soft tissue coverage
6
Q
Nerves
WD and TR Surgical Techniques
A
- Traditional approach: gentle traction neurectomy
- painful neuromas are very common
7
Q
WD Surgery Advantages
A
- preservation of distal radioulnar joint
- preserves pronation/supination range of approx 100-120 deg
- increase leverage due to limb length
8
Q
WD Surgery Disadvantages
A
- Length limits wrist/TD component options
9
Q
TR Surgery Considerations
A
- at least 2/3 of forearm length should be maintained when practical
- Removal of 6-8 cm allows for soft tissue envelope and allows “space” for distal components
- Tissue should be superimposed between radius and ulna to prevent painful radioulnar convergence
10
Q
TMR
Surgical Approaches for Nerve Treatment
A
- targeted muscle reinnervation
- initially implemented as a way to improve muscle activation for myoelectric prosthesis control
- secondary benefit: Reduction of neuroma formation and associated reduction of pain
11
Q
Regenerative Peripheral Nerve Interface
Surgical Approaches for Nerve Treatment
A
- no neuroma formation in animal subjects
- human subject able to proportionally control prosthetic hand in real time
- reduces phantom limb pain
12
Q
Strength
Upper Limb Amputation Evaluation
A
- Strength should be evaluated for: Gross motions, muscle belly contractions
- possible sources of weakness: Loss of lever arm, nerve damage, lack of myodesis, deconditioning
13
Q
Elbow Flexion ROM
Upper Limb Amputation Evaluation
A
- treat as baseline (ROM without prosthesis)
- Goals to maximize uses of range along with a prosthesis
some cases cost of stability of px can reduce available rom at joint
14
Q
Forearm Pronation/Supination
Upper Limb Amputation Evaluation
A
- WD will preserve more of this motion
15
Q
Limb Length Effect on Forearm Pronation/Supination
Upper Limb Amputation Evaluation
A
- Shorter skeletal length, smaller preserved ROM for total forearm rotation
- WD: 120 of availble forearm rotation range
- Medium: 100 deg
- Short: 60 deg
- Very Short (35% or less of full skeletal forearm length): 0 deg
