10] UE Amputees And Prosthetics Flashcards
Main causes of UE limb loss
Vascular disease
Trauma
Cancer
Ratio of UE amputees to LE
1:5
70% of all persons with UE amputations are
Distal to the elbow
With ROM and MMT pay attention to
Scapula
Cognition testing outcome measures used
MoCA
SLUMS
MMSE
Surgical incision goal
Promote closure
Surgical incision treatment focus
Reduce edema
Protect incision
Prevent adhesions
Wound bed prep goal
Promote granulation bed and then epithelialization
Wound bed prep is achieved through (3)
Serial debridement
Surgical debridement▫
Local wound care
Technique of massage and tapping of the
residual limb starting the 1st day after surgery to help reduce and control pain through self
management.
Skin desensitization
Benefits of skin desensitization
●pain control, establishment of body imageand psychological adjustment
Needed skill of skin desensitization for 2 reasons
- Pt knows their tolerance and can easily administer based on their own comfortlevel.
- Allows the patient to become accustomed
to their body after surgery.
Skin mob purpose
Maintain pliability and motion o prevent blisters during prosthetic use
When can you start skin mobs
Right after surgery
Ideal shape of limb
Cylindrical because its easiest to don and greatest weight bearing surface
Volume containment options
- Compression Wrapping
- Stump Shrinker
- Tubigrip
- Unna’s Boot
Compression wrap is used for
Volume control, Stump shaping, Desensitization.
Compression wrap direction
Proximal to distal diagonals
Rewrap compression wrap when?
Every 4 hours
Once sutures are removed, what can be used?
Stump shrinker usually 2-3 weeks after surgery
- not durable
- increased cost
- can roll and constrict
- can cause window edema at end
- difficult to purchase out of hospital
Disadvantages of tubi-grip
•Gauze impregnated with
calamine lotion or zinc oxide.
Unna’s boot
How does Unna’s boot work
Apply it without any tension; tightens as it dries and ace wrap over it lightly
Unna’s boot is effective for
Rapid volume reduction; NOT for ongoing volume containment
Semi-rigid Unna’s boot advantages
- excellent edema control/reduction
- allows skin check very 3 days or can be left up to 1 week
- promotes wound healing in venous insufficiency
•Messy to apply •Can be expensive over time •Must be applied by a clinician. •Draining incisions can cause maceration
Disadvantages of Unna’s boot
tension applied to nerve
prior to division resulting in proximal retraction of the nerve away from distal limb.
Traction neuroectomy
Pharmacological interventions for phantom limb pain
Gabapentin
Neurontin
Centrocentral nerve union
2 severed nerves are coapted to make a loop
How do you progress them to the next level with GMI?
Correctly identify 20 images within 2 seconds being 80% accurate
Contractures more prevalent with
Increasing muscle imbalance and non-use of affected extremity
Risk factors for contractures (5)
- Immobilization / Non-use
- Lack of Education
- Muscle Imbalance
- Tone
- Pain
Common contractures
Shoulder flex/abd
Scapular winging
Scoliosis
Positioning for contractures
Avoid pillow positioning
Special emphasis for strength training focused on
Scapular and Shoulder stabilizers
Core strengthening is essential for
Prosthetic control
Sitting and tending posture
Reducing stress to the spine that could lead to LBP
Significant evidence that it is critical to fit the the unilateral amputee patient with prosthetic in
First 6 months b/c theres a high incidence of rejection due to them getting used to one hand
Most common amputation level
Transradial (57%)
Digit or Partial Digit amputation
Partial hand amp
Amputation transecting the carpal bones
Transcarpal amp
What is preserved with transcarpal amp?
Wrist flexion/extension and forearm supination/pronation arepreserved
Carpal bones are disarticulated from the radius & ulna
-Styloid process is trimmed
Wrist disarticulation
Amputation through the radius and ulna from level of wrist to the elbow
Transradial amp
The radius and ulnaare disarticulated
from the humerus
Elbow disarticulation
Transection of humerus anywhere from the humeral head to the elbow
Trans humeral amp
Humerus is disarticulated from the Glenoid fossa, scapula and partor all of the clavicle remain
Shoulder disarticulation
amputation of part or all of the scapula & clavicle. - Usually a last resort to remove cancer
Forequarter amputation
Advantages of body powered prosthesis (5)
- Heavy Duty Construction
- Proprioception
- Less Expensive
- Lighter in Weight
- Reduced Cost and Maintenance
3 parts of body powered
Socket
Suspension
Terminal device
3 independent motions of triple control harness
- activation of
terminal device - elbow joint lock / release
- forearm flexion
Patho of electromyography
Acetylcholine initiates an action potential that is passed in the
direction of muscle fibers across sensors embedded in prosthetic socket.
Residual nerves from the amputated limb are transferred to reinnervate new muscle targets that have otherwise lost their
function
Targeted muscle reinnervation
Direct structural and functional
connection between living bone and
the surface of a load-carrying implant.
Osseointegration
What two types of prothestics can be used for any amp level?
Passive and myoelectric
Hybrid can only be for what amp
Shoulder disarticulation
Body powered only for which amps?
Partial hand
Trans radial
Trans humeral
