MT: Intro to NURIC Flashcards
Desired Features vs NURIC
- proper contours for functioning muscles - RF and Gluteal Channel
- stabilizing - ischial containment/shelf
- distribute pressures - support gluteal muscles
- precise contouring - not forcing limb into quad shape
- total contact - prevent distal end edema
Biomechanical Objectives: Coronal Plane
- provide ML stability of the pelvis during midstance on prosthetic side
- conserve energy by minimizing lateral displacement of CoG
Early Ischial Containment
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- recognized need for narrow ML
- to allow coronal plane stability
- align head of femur and distal aspect of the femur
TF Specific considerations
- evaluate & accommodate ROM in hip extension and permit normal stride on contralateral side
- flexor and extensor muscles accommodated inside socket
- adductor shape can vary with design
Critical Design Features
- axial support
- compartments of NURIC socket
- amount/degree of containment
- alignment
- objective measurements
Axial Support
- ischial support (direct skeletal support)
- gluteal support
- hydrostatic support
Ischial Support
- critical for patients with minimal muscle tone
- inadequate support may result in ramus pressure and reduced comfort
Gluteal Support
- achieved by appropriate socket contours (proper shelf height)
- critical for short residual limbs
- aids in general loading and comfort
Hydrostatic Support
- achieved by volume reduction (tension values)
- volume reduction to compress tissues
Compartments of NURIC Socket
- anterior
- medial
- lateral
Anterior Compartment
- adductor longus relief
- femoral (scarpa) traingle compression
- rectus femoris relief
- tensor fascia lata/ASIS relief
- opposing ischial support
What are the boundaries of scarpa’s triangle
- inguinal ligament
- sartorius
- adductor longus
What does the contour of the rectus area provide?
counter force to stabilize ischium in proper location
Rectus Channel Goals
- provides equal distribution of pressure between firm and soft tissues
- control rotation
- allow room for functioning muscles
Medial Compartment
- medial wall internal rotation relative to LOP
- Sub-ischial triangle
- medial brim flaring
- ramus relief
Internal Rotation of Medial Wall
- pre-compress adductors
- facilitate early stance phase loading
- prevents lateral shifting of socket
Sub Iscial Triangle Boarders
- inferior pubic ramus
- semitendinosis
- Gracilis
Medial Brim Flaring
- prevent adductor roll
- protects distal aspect of ramus from excessive pressue
- no vertical component at all
Adductor Roll Caused by
- tight scoket
- inadequate flaring of prox/medial brim
- too low medial wall
- patient not getting into socket !!!!!
Lateral Compartment
- Stabilization of femur
- relief for lateral distal femur
- proximal lateral cupping
- externally rotated
Lateral Wall Contours
- proximal lateral cupping reduces gapping during mid-stance
- lateral wall stabilized femur
Amount of Ischial Containment
- greater containment distributes forces over a larger area
- contributes to coronal plane stability
- does not produce “skeletal lock”
Socket Flexion
- Allows for even step length on sound side
- puts extensors on stretch and at functional advantage
Socket ADduction
- allows loading of lateral femur
- puts hip Abductors on stretch and at functional advantage
- places femur in anatomical alignment
Goals of Medial AP measurement
- ischial support
- medial containment
- locate ischium in impression
Goals of Lateral AP measurement
- gluteal loading
- prevent anterior gapping while seated
- allow sufficient room for adductor musculature
Subischial Triangle
- provides loading distal to the ischial containment
- decreases load on ischium
- compresses adductors to aid in their functinoing
- parallel to ischium