UE Amputation Flashcards
___% of all amputations are upper limb loss
3%
what are common causes of UE amputations?
trauma
tumor
what are problems specific to UE amputations?
self esteem
psychological impact
less research
loss of dexterity
different grasping patterns
shaking hands
hand dominance
when should we fit a patient with an UE prosthesis for best outcomes?
the earlier the better
which digit would be indicative of worse prognosis in a partial hand and digit amputation?
thumb –> used more for function
wrist disarticulation:
– better potential for ______
– allows _______ at terminal end
– better surface area for _____
– limited prosthesis options due to ______
– active supination/pronation
– WBing
– suspension
– short working length
transradial:
– (more/less) favored and prosthetic options
– (easier/harder) prosthetic fit
– preservation at _____ for ideal function
– at least ______ of ulna necessary for functional use of elbow
– more
– easier
– elbow
– 5 cm
in children, is elbow disarticulation or transhumeral amputation more desirable? why?
elbow disarticulation
- transhumeral amputations result in higher incidence of bony regrowth
in adults, is elbow disarticulation or transhumeral amputation more desirable? why?
long transhumeral favored - at least 5-7 cm of humerus to preserve shoulder function and prosthesis use
- elbow disarticulation allows for better device suspension and control
harness suspension, self-suspending, and adjustable sockets are all _____ designs
socket
suspension methods:
– one-way valve, passive
– active pump (noisy), minimizes pistoning
– over socket & connects with skin to stay on
– shuttle ____/pin
– suction
– vacuum
– outer sleeve
– lock/pin
what suspension method has good implications for a patient that has skin breakdown and sweats a lot?
– with this suspension method, what do you need to be cautious about?
osseointegration
– fractures –> rod always sticks out
liner (gel or silicone), socks, and flexible inner socket are all __________
– which one is most common?
sockets interaces
– liner
cosmetic/passive prosthetic:
– active/electronic parts??
– intended to:
– primarily for _____ use
– may assist with:
– no
– closely resemble natural body part
– cosmetic
– pushing, balancing, or supporting objects
what ROM needs to be addressed for each level of amputation:
– transhumeral
– transradial
– wrist disarticulation & long transradial
– any level
– shoulder depression, extension, abduction
– elbow flexion, extension
– forearm pronation and supination
– scapular abduction and humeral flexion
how are body powered prostheses powered?
exaggerated movement of shoulder/s, neck and back
harness systems
how do the body powered prostheses voluntarily open and close?
tension is applied to the cables
in someone with a transradial amputation and body powered prostheses, how is tension created to open and close?
shoulder flexion and scapular protraction
in someone with transhumeral amputation and body powered prostheses, how is tension created to open/close and lock elbow?
- shoulder flexion, scapular protraction for elbow control
- lock elbow using shoulder extension and scapular depression to control terminal device using a dual cable
what are advantages of body powered prostheses?
lower initial cost
lighter weight
easy to repair
what are disadvantages of body powered prostheses?
mechanical appearance
lack fine motor control
may be difficult to use
how does externally powered/myoelectric prostheses work?
user contracts muscles of the residual limb, generating EMG signals that control the motor of hand/wrist/elbow functions
what are advantages of externally powered/myoelectric prostheses? (3)
no harness or cable system, built to look more realistic
battery powered - doesn’t depend on patient strength
provide a forceful grip
what are disadvantages of externally powered/myoelectric prostheses? (4)
higher initial cost
heavier
higher cost to repair
poor battery life
a hybrid prostheses combines:
use of body powered and externally powered prosthetic components
what is targeted muscle reinnervation? (TMR)
surgical procedure that reassigns nerves
how does TMR work?
use of pattern recognition to distinguish movements involving multiple degrees of freedom
what is the benefit of TMR?
helps to better control prosthetic device
a prosthesis with an elbow joint allows for ______ and can have _______
flexion/extension ; rotation (sup/pro)
a prosthesis with a wrist joint allows for ______ and can have _______
flexion/extension ; rotation
a wrist joint is often a part of ____
hand component
what are 3 examples of terminal devices?
what’s the purpose of them?
hooks/split hooks
prehensors
artificial hands
– replaces the hand to make them more functional
what are hook devices used for?
hold object between hook
they can see the object they are trying to hold
what are advantages to hook devices?
– disadvantage?
durable
low maintenance and repair cost
lightweight
– cosmetic problem
what are prehensor devices?
similar functionality to hook
hook like - looks like lobster claws, pliers, birds beak
what are disadvantages to prehensors?
difficult to pick up small objects
bulkier than split hook
what are advantages to artificial hands?
cosmetically appealing
pattern recognition for improved motor skills
what are disadvantages to artificial hands?
more degrees of freedom to control, with articulating fingers
more difficult to learn how to use
true or false. most UE amputees wear their prostheses all the time
false - 30-80% abandon their prosthetic
what are some outcome measures that can be used for UE amputees?
box and block test
suitcase packing activity
Self-Report: QuickDASH, PROMIS-9 UE, OPUS, UEFS, PSFS
what are some advanced surgical procedures for UE amputees?
thumb reconstruction by digital transposition (toe replaces the thumb)
hand/arm transplantation
a cosmetic upper limb prosthesis would be most effective during which of the following functional tasks?
a) buttoning a shirt
b) opening a doorknob
c) holding a can of soda
d) pushing a door open
d) - cosmetic upper limb prosthesis are designed for assisting with pushing, balancing, or supporting objects
