Amputation and Prosthetics Flashcards
Primary etiology for amputation
Second
peripheral vascular disease
diabetes
forequarter (scapulothoracic) amputation
upper extremity including the shoulder girdle
shoulder disarticulation
UE through shoulder
Transhumeral
UE proximal to elbow joint
elbow disarticulation
lower arm and hand through elbow joint
transradial
UE distal to the elbow joint
wrist articulation
hand through wrist joint
partial hand
portion of the hand and/or digits at either the transcarpal, trasmetacarpal or transphalangeal
digital amputation
removal of a digit at either metacarpophalangeal, proximal interphalangeal or distal interphalangeal
Hemicorporectomy
removal of pelvis and both LE
hemipelvectomy
removal of on half the pelvis and LE
knee disarticulation
removal of the LE through knee joint
Syme’s
removal of the foot at the ankle joint with removal of the malleoli
transvers tarsal (Chopart’s)
through talonavicular and calcaneocuboid joints. preserves plantar flexors but sacrifices the DF resulting in equinus contracture
Tarsometatarsal (Lisfranc)
removal of the metatarsals
preserves DF and PF
Transradial socket covers….
may be shortened to allow for ….
supracondylar sockets are …. and require no additional harness
2/3 of forearm
increased pron/sup
self-suspending
Transradial suspension options
triceps cuff
harness
cable sys
Transradial elbow unit attaches to either … or upper arm pad.
… or….connects socket to proximal component.
triceps cuff
flexible or rigid
Transradial wrist unit has what options
quick change unit
wrist flexion unit
ball and socket
constant friction
Transradial terminal device has voluntary … or…
powered by….
type of hand
opening or closing
body-powered, externally powered, myoelectric or hybrid
hook, mechanical hand, cosmetic glove
Transhumeral socket extends to …
modified design allows for stability with…
….units may be used with passive prosthetic arms
acromion level
rotational movements
lightweight friction
Transhumeral suspension
harness
cable sys
suction
Transhumeral elbow unit
internal or external locking elbow unit
Transhumeral wrist unit and terminal device
same as transradial
Transfemoral socket
quadrilateral socket
ischial containment socket
Transfemoral suspension
lanyard strap
shuttle lock
suction
partial suction
vacuum
Transfemoral knee
single axis
polycentric
hydraulic
microprocessor
Transfemoral shank
exoskeleton-rigid
endoskeleton-pylon covered with foam
Transfemoral foot system
solid ankle cushion heel
stationary attachment flexible endoskeleton
single axis
multi-axial
hydraulic
powered
dynamic response
Transtibial socket
patella tendon bearing
supracondylar patella tendon socket
supracondylar suprapatellar socket
Transtibial suspension
supracondylar cuff
thigh corset
supracondylar brim
rubber sleeve
waist bel with fork strap
suction with knee sleeve
shuttle lock
vacuum
Transtibial knee
is not needed
Transtibial shank and foot sys
same as transfemoral
Rigid plaster of paris allows for early…
promotes…
stimulates…
provides… and …
limits….
ability to utilize…
ambulation with pylon
circulation and healing
proprioception
protection and soft tissue support
edema
IPOP
Rigid plaster of Paris make immediate … inspection not possible.
Does not allow for …
Requires…
wound inspection
daily dressing change
professional application
NWB Rigid removable limb protectors are …. accomodate…. are easily ….prevent… and provides….
removable
edema fluctuation
applied
contracture
protection
NWB rigid removable limb protectors are not used for …
ambulatory purposes
Semi-rigid (unna paste, air splint) reduces….provides… and …. and are easily…
post-op swelling
soft tissue support and protection
changeable
Semi-rigid does not protect as well as ….requires more….may loosen and allow for …
rigid dressing
more changing than rigid
development of edema
Soft (ACE wrap, shrinker) reduces …, provides some…, relatively ….., easily removed for ….. allows for active joint ….
post-op edema
protection
inexpensive
wound inspection
ROM
Soft causes interruption of…. due to frequent dressing changes.
Joint ROM may…. healing of incision.
Less control of ….
cannot control amount of …. on bandage.
Risk of …. effect.
Shrinker cannot be applied until…
tissue healing
delay
residual limb pain
tension
tourniquet
sutures/staples are removed
K level is associated with
componentry that will be used for prothesis
current level of function, potential ability for function and patients particular needs.
K level is determined by
AMPPRO or through a thorough history and examination of patient. PT can make this level
K level 0
prothesis will not enhance quality of life or mobility
will not be eligible for prosthesis
K level 1
transfers
ambulate on level surfaces
fixed cadence
limited or unlimited household ambulator
knee will be single axis or constant friction
ankle will be SACH or single axis
K level 2
traverse low-level barriers
limited community ambulator
knee will be polycentric or constant friction
ankle will be flexible keel foot and multi-axial ankle
K level 3
variable cadence ambulator
unlimited community ambulator
traverse most environmental barrers
prosthetic use beyond simple locomotion
knee will be hydralic, microprocessor, or variable friction.
ankle will be energy storing, dynamic response, mutli-axial foot
K level 4
exceeds basic ambulation skills
exhibits high impact levels
child, athlete or active adult
any systems for knee and foot
What areas are more tolerant for a socket?
muscular
common design for transfemoral
ischial containment
common design for transtib
total surface bearing or patellar tendon bearing socket
liners are typically
gel and non-breathable so need to dry it.
An insert can accomodate for …
space in socket
foam or flexible plastic
hard insert can
relieve pressure through a series of buildups and reliefs molded in the insert
Sock is worn to decrease limb volume especially in
first year
Common plys of sock are
1,3,5
General rule of thumb with socks
number of socks exceed 12-15, prosthetist needs to recast
Pressure tolerant areas on transtib
patellar ligament
lateral fibula shaft
medial tibial shaft
lateral tibial shaft
Pressure sensitive areas on transtib
fibular head
lateral tibial flare
tibial crest
distal end of fibula and tibia
patella
anterior tibial tubercle
peroneal nerve
adductor tubercle
Pressure tolerant areas on transfem
ischium
soft tissues of residual limb
Pressure sensitive areas on transfem
greater trochanter
pubic tubercle
pubic ramus
pubic symphysis
distal end of femur
perineum
Lotion for limbs should be….and should not be applied prior to ….because it might inhibit suspension. If there is any breakdown of skin it should be….
not be petroleum based
donning prosthesis
prosthestist or physician before donning
Break in schedule for prosthetic
first few weeks
start with one hour of wear time a day with half of that being walking
every 30 min inspect skin
if tolerating all this well increase time to one more hour each day.
When skin is doing well with no signs of breakdown, amount of time between inspections becomes 15-30 min more
Most common complaint with a new prothesis is the
comfort of the socket
Pre-prosthetic phase
6 weeks immediately post-op
focus on protecting limb, preventing contractures, developing single limb mobility skills and preparing for prosthetic phase
sometimes will be fit with IPOP-allows for immediate WB
Patient will be evaluated for first prosthesis once ..
.sutures or staples are healed and skin integrity is intact 4-6 weeks.
can begin wearing a shrinker when staples are removed
First get a temporary prosthesis then go to
prosthetic phase of rehab
How long does it take to get a good comfort and fit and what is required to get a permanent prosthesis
several months
volume fluctuations have stabilized
What wrapping strategies should you use with residual limbs?
no wrinkles
diagonal and angular pattersn
no circular patterns
provide pressure distally to enhance shaping
anchor wrap above knee for transtib and around pelvis for transfem
promote full elbow extension for transradial
promote full knee extension for transtib
promote full hip extension for transfem
secure wrap with tape not clips
use 2-4 in wrap for UE
3-4 in wrap for transtib
6 in wrap for transfem
rewrap frequently
Common complications followed amputation
contractures
DVT
hypersensitivity
neuroma
phantom limb
phantom pain
psychological impact
wound infections
most likely contractures for transmet and Symes
equinus
most likely contracture for transtib
knee flexion
most likely contracture for transfem
hip flexion and abduction
Most common cause for forequarter amputation
loss of all what joint movements
malignancy
shoulder, elbow and hand
functional prosthetic is common
Shoulder disartic is the loss of what joint movements?
Most commonly result of …?
Functional prosthetic use ….
What kind of shoulder?
all shoulder, elbow and hand function
malignancy and severe electrical injuries
is possible
external prosthetic shoulder joint is typically required
Two most common UE amputations
transradial
transhumeral
Transhumeral is the loss of all…
most commonly due to…
typically __-___cm proximal to the distal humeral condyles.
If trauma associated fracture, dislocation or peripheral nerve injury it may….
elbow and hand function
trauma
7-10
delay prosthetic interventions
Elbow disarticulation is the loss of all…
most commonly due to …
allows for …. socket.
an external prosthetic …. is required.
elbow and hand function
trauma
self-suspending
elbow joint
Transradial is the loss of all …
must be a minimum of ___cm proximal to distal radius.
Typically caused by…
If it is trauma, dislocation or peripheral nerve injury it may…
Functionally perferred over …. or …
all hand function
5
trauma
delay prosthetic interventions
wrist disarticulations or selected partial hand amputations
Wrist disarticulation is ….
loss of all…
.. and …. prosthetic disadvantages
uncommon
hand function
cosmetic and functional
Partial hand amputation is the loss of a …
limb sparing technique utilized when…
toe transfer to replace … may be considered if prosthesis fails
digit/hand function
functional pinch can be preserved
thumb
Digit amputation preserved function is highly variable depending on ….
protheses are ….
long transradial amputation may be more… if multiple digits are involved at proximal levels.
number of digits involved and level of amputation
not typically utilized
functional
Hip disarticulation/hemipelvectomy all functions of ….
most common cause…
does not allow for activation of….
prosthetic limb advancement is initiated through…
hip, knee, ankle, and foot are absent
malignancy
prosthesis through residual limb
pelvic motion
Transfem length of residual limb with regard to…
knee componentry will determine ability to …
stance control may not activate until…
donning can be more difficult than with …
WB through ischium in an ….
susceptible to ….
adaptation required for balance….
leverage and energy expenditure
functionally reciprocate gait
WB occurs through limb
transtib
ischial containment socket
hip flexion contracture
weight of prosthesis and energy expenditure
Knee disartic loss of all ….
residual limb can …
susceptible to ….
knee axis of prosthesis is…
gait deviations can occur secondary to…
knee, ankle and foot function
WB through its end
hip flexion contractures
below the natural axis of the knee
malalignment of knee axis
Transtib loss of …
WB in prosthesis should be …
areas of primary WB should be…
adaptations required for…
susceptible to both …
active foot and ankle motions
distributed over the total residual limb
pressure tolerant
balance
knee and hip flexion contractures
Symes loss of …
residual limb can WB…
residual limb is … with non-cosmetic appearance.
dog ears must be …. for proper prosthetic fit.
adaptation required for increased…
adaptation required due to ….
all foot functions
through its end
bulbous
reduced
weight
diminished toe off
Trasmet and choparts is loss of ___,___,___,___ and tendency to develop.
forefoot leverage
balance
WB surface
proprioception
equinus deformity
Prosthetic causes of lateral bending
too short
improperly shaped lateral wall
high medial wall
prosthesis aligned in abd
Amputee causes of lateral bending
poor balance
abd contracture
improper training
short limb
weak abd on prosthetic side
hypersensitive and painful residual limb
Prosthetic causes of abducted gait
too long
high medial wall
poorly shaped lateral wall
prosthesis positioned in abd
inadequate suspension
excessive knee friction
Amputee causes of abducted gait
abd contracture
improper training
adductor roll
weak hip flexors and adductors
pain over lateral residual limb
Prosthetic causes of circumducted gait
too long
excessive knee friction
socket is too small
excessive PF
Amputee causes of circumducted gait
abd contracture
improper training
weak hip flexors
lacks confidence to flex knee
painful anterior distal residual limb
inability to initiate prosthetic knee flexion
Prosthetic causes of excessive knee flexion during stance
socket set forward in relation to foot
excessive DF
stiff heel
too long
Amputee causes of excessive knee flexion during stance
knee flexion contracture
hip flexion contracture
pain anteriorly in residual limb
decrease in quad strength
poor balance
Prosthetic causes for vaulting
too long
inadequate socket suspension
excessive alignment stability
excessive PF
Amputee causes for vaulting
residual limb discomfort
improper training
fear of stubbing toe
short residual limb
painful hip/residual limb
Prosthetic cause for rotation of forefoot at heel strike
excessive toe-out built in
loose fitting socket
inadequate suspension
rigid SACH heel cusion
Amputee causes for rotation of forefoot at heel strike
Poor muscle control
improper training
weak medial rotators
short residual limb
Prosthetic causes for forward trunk flexion
socket too big
poor suspension
knee instability
Amputee causes for forward trunk flexion
hip flexion contracture
weak hip extensors
pain with ischial WB
inability to initiate prosthetic knee flexion
Prosthetic causes for medial or lateral whip
excessive rotation of the knee
tight socket
valgus in prosthetic knee
improper alignment of toe break
Amputee causes for medial or lateral whip
improper training
weak hip rotators
knee instability
Limb loss specific out come measures: functional
AMPPRO-Amputee mobility predictor
L-test
AMPPRO
measure ambulatory potential of lower-limb prosthesis users. K-level
L-test
assess amputee mobility
Like the TUG but some differences: 90 degree turn is performed after initial 3 meters, total length ambulated is 20 meters not 6 like the TUG, four turns are involved.
Limb loss specific outcome measures: patient based outcomes
Prosthesis Evaluation Questionnaire (PEQ)
Orthotics Prosthetics User Survey (OPUS)
Trinity Amputation and Prosthesis Experience Scales-revised (TAPES-R)
PEQ
evaluate the prosthesis and life with it
9 scales that can be administered together in independently.
Visual analog scale to assess satisfaction, well-being, frustration, pain, and residual limb health.
OPUS
functional status, quality of life, satisfaction modules
simple and be performed in part or in whole
TAPES-R
multidimensional instrument examines psychosocial process involved in adjusting to using an a prosthesis.
Four sections: activity restriction, psychosocial adjustment, satisfaction with prosthesis, and factors influencing health both related to and unrelated to amputation.
Takes 15 min to administer and may be given in part or in whole.
Acquired amputation
disease, trauma, infection
traumatic or non-traumatic
Endoskeletal shank
rigid pylon covered in material designed to simulated the contour and color of the contralateral limb
Exoskeletal shank
rigid external frame covered with a thin layer of tinted plastic to match the skin color distally
myodesis
anchoring muscle or tendon to bone using sutures drilled in bone. Help in closure process on residual limb.
myoplasty
suturing amputated muscle flaps together over the end of a bone
osseointegration
process of implanting a prosthetic device directly into residual limb of a person with limb loss. Negates the need for socket component.
polycentric knee
multiple axes of rotation for more natural gait cycle
pylon
pipe like structure used to connect the socket to the foot/ankle components assists with WB and shock absorption
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