Upper Ext 2 Flashcards
Partial Hand Amputation
Any AMPUTATION DISTAL TO THE WRIST
LEAST INVOLVED of the UE amputations
Can be as minor as losing DISTAL PART OF PHALANGE major as LOSING ALL THE METATARSALS
Wrist Disarticulation
TRANSECTION THROUGH WRIST
Carpals are disconnected from radius and ulna
Trans-Radial (Below Elbow)
Amputation that occurs BELOW ELBOW JOINT and PROXIMAL TO THE WRIST
Can be classified further as LONG, MEDIUM, SHORT, VERY SHORT
Ideally beneficial for trans-radial to be LONG ENOUGH that it is at least PAST THE BICIPITAL TUBEROSITY, SHORT ENOUGH to allow approximately 3.5 cm for wrist unit
Elbow Disarticulations
Amputations that TRANSECT THE ELBOW JOINT
Trans-humeral (above elbow)
Amputations that occur THROUGH THE HUMERUS
STANDARD LENGTH for trans-humeral limb is 50-90% of original length
Prosthetic considerations include SUSPENSION and ROTATION control
Shoulder disarticulations
Amputations of the COMPLETE HUMERUS at the Gleno humeral joint and everything distal
Commonly due to TRAUMA AND AVULSION
Interscapulothoracic Disarticulation (Forequarter)
Amputations are commonly performed due to OSTEOSARCOMA OF SHOULDER GIRDLE
Amputation removes the SHOULDER GIRDLE INCLUDING THE SCAPULA and ALL OR PART OF THE CLAVICLE
Why Disarticulations?
NOT AS VALUABLE in UE as LE
DISTAL END WEIGHT BEARING NOT AS ADVANTAGEOUS
However, SPECIAL CONSIDERATIONS for children due to GROWTH
Want to PREVENT OVERGROWTH in a transected bone
Disarticulations are ARGUABLY LESS COSMETIC
ADVANTAGES include SUSPENSION and RETENTION of PHYSIOLOGIC POSITION of the TERMINAL DEVICE IN SPACE
Amelia
COMPLETE ABSENCE OF LIMB
Phocomelia
VERY SHORT LIMB, usually terminating with a FUNCTIONAL HAND
Terminal Transverse Hemimelia Above-Elbow
Congenital ABOVE ELBOW AMPUTATION
Terminal Transverse Hemimelia Below-Elbow
Congential BELOW ELBOW AMPUTATION
MOST COMMON OF CONGENITAL LIMB DEFICIENCIES
Acheiria
ABSENCE OF HAND
Congenital wrist disarticulation
Longitudinal Deficiency (Radial or Ulnar) Hemimelia
RADIAL is far more common
These usually present with a FUNCTIONAL HAND
Main issue is RADIAL/ULNAR DEVIATION
RARELY REQUIRE PROSTHETIC CARE
Milbrant Device
Originally developed in British Columbia for lumberjacks
Used to REPLACE MISSING DIGITS 2-5
Device is traditionally made of leather with buckle closure for durability
FINGER BAR has HIGH FRICTION material
Opposition post
SMALLER IN SIZE than the Milbrant
Used for LIGHTER TASKS and is better suited for FINE DETAIL
Spatula
LIGHT DUTY device used when there are NO FINGERS PRESENT
WRIST MOTION in order to use device
Functional loss
THUMB represents GREAT PORTION OF FUNCTION of our hands
If AMPUTATED AT MC joint, there is 40% loss in hand function, 100% loss of thumb function
If ALL PHALANGES ARE AMPUTATED, it is considered a 100% loss of the hand
Conventional Prostheses
PASSIVE
BODY POWERED
Passive prostheses
Have some MANUAL OPPOSITION functions
Also provide “COSMETIC” coverage of the residuum
Body powered prostheses
Usually controlled by using CABLE SYSTEM
Quite DURABLE, have BETTER SENSORY FEEDBACK
These types of prosthesis are NOT AS COSMETICALLY PLEASING as externally powered controlled type
REQUIRE LARGE ROM to control function of prostheses
Trans-radial Body-Powered Prosthesis PARTS
Includes
- Single control harness system
- Control cable system
- Triceps Cuff
- Elbow Hinges
- Laminated Socket
- Interface
- Wrist Unit
- Terminal Device
Grip Types (8)
- Key
- Chuck (3 point)
- Span (C in web space)
- Hook (carry suitcase handle)
- Power (grab rod)
- Disc (holding door knob)
- Flat hand push (push wall)
- Finger push
UE Statistics
50 000/yr in US
Ration UE to LE is 1:4
MOST COMMON is PARTIAL HAND AMPUTATION with loss of 1 or more fingers
WRIST HAND AMPUTATIONS make up 10% of upper limb population
TRANRADIAL AMPUTATIONS make up 60% of total wrist and hand amputations
70% of all persons with upper limb amputations have amputations DISTAL TO ELBOW
Trans Radial Length Classification
LONG- longer than 2/3
MED- 2/3 to 1/3
SHORT- 1/3 or shorter
PRONATION/SUPINATION decreases with decreasing length
Wrist Disarticulation
Characterized by OVAL DISTAL END
DISTAL JOINT retained therefore GREATER ROM in PRONATION/SUPINATION
Laminated Socket Types (5)
- SUPRACONDYLAR (Northwestern)
- 3/4 Socket
- MUENSTER Socket (NARROW A-P)
- BASIC Socket
- SCREWDRIVER Socket
Northwestern (SUPRACONDYLAR)
Developed at Northwestern University in Chicago
SELF SUSPENDING, presses medially and laterally proximal to epicondyles
Has LOWER ANTERIOR PROXIMAL TRIMLINE than Muenster to allow for more Elbow Flexion
3/4 Socket
Developed at Hugh Macmillan Centre in Toronto
Similar to Northwestern, except there is POSTERIOR OPENING OVER OLECRANON
4 “QUADRANTS”, quadrant around olecranon didn’t serve a function, quadrant was cut out, hence 3/4 socket name
Result is socket that is LESS CONSTRICTING, ALLOWS MORE AIRFLOW which is beneficial in myoelectric sockets where wicking socks cannot be worn
ELBOW ROM and COSMESIS is also improved with cut out
Muenster Socket
Developed University of Muenster
SELF SUSPENDING socket
NARROW A-P, sometimes referred to as A-P Socket
ANTERIOR PROXIMAL TRIMLINE is generally HIGHER and ELBOW FLEXION can be LIMITED by tissue bulging in the cubital area during flexion
Socket is BENEFICIAL FOR SHORT TRANSRADIAL
Disadvantages, are LIMITED FLEXION capabilities, DIFFICULTY DONNING
Basic Socket
Trimlines are DISTAL TO EPICONDYLES AND OLECRANON
Can be SUSPENDED using DIFFERENT types of METHODS
TRICEPS CUFF and HARNESS to attach the HINGES and the socket
Using a LINER WITH A PIN at the distal end
SUCTION OR NEGATIVE PRESSURE using a valve and sleeve ca
Screwdriver Socket
DESIGN is used for LONG RESIDUUM (at least 60% of the remaining forearm)
DISTAL 1/3 OF SOCKET IS FLATTENED in the SAGITTAL PLANE to stabilize the radius and ulna to be ABLE TO PRONATE/SUPINATE the prosthesis
TRIMLINE is typically CUT BELOW EPICONDYLES AND OLECRANON
Interface Options
SOCKS
SKIN FIT
SILICONE LINER
Wrist units
DEPENDENT ON LENGTH of remaining limb (BUILD HEIGHT)
Very long limbs need specialized wrist units
Options are
- QUICK DISCONNECT (QD)
- FRICTION
- Flexion/Radio-ulnar deviation (OMNI)
- LOCKING
Bilateral considerations for Wrist Units
FLEXION UNITS ARE IMPORTANT FOR GETTING TO MIDLINE
Aids with ADLs (Activities of Daily Living), buttoning shirts etc.
Quick Disconnect Wrists PROs
EASY TO SWAP terminal devices
LOCKING OPTION is available
Gives more FUNCTION
Quick Disconnect Wrists CONs
HEAVIER than friction wrists
MORE MECHANICAL PARTS
MORE COSTLY
LONGER BUILD HEIGHT NEEDED
Friction Wrists
LOWER BUILD HEIGHT than most QD
CAN BE SHAPED TO OVAL SHAPE OF DISTAL FOREARM for greater cosmesis
ADJUSTABLE TERMINAL DEVICE PRONATION/SUPINATION with washers or set screws
Flexion Wrist Unit
FLEXION WRIST can only provide flexion and is for conventional only
OMNI wrist has ROM in all planes, can be used for conventional or myo
Terminal Devices
PASSIVE OR ACTIVE
Passive Terminal Devices
MOST COMMONLY PRESCRIBED passive terminal device is passive hand
Can be for STATIC GRASP, cosmesis (social acceptance)
COSMETIC - hands, off the shelf glove, silicone finished
OPERATED BY CONTRALATERAL HAND, environment, or does not move
TASK SPECIFIC / ACTIVITY BASED device (bicycle, hockey, baseball etc.). SPORTS, SPECIALIZED ACTIVITIES
Active Devices
Can be either HOOKS OR HANDS
Provide 3 POINT CHUCK ACTION
Most hooks provide the equivalent of active lateral pinch grip
ACTIVE PROSTHETIC HAND is more COSMETICALLY pleasing but usually HEAVIER AND BULKIER than a hook
Can be VOLUNTARILY OPENING, VOLUNTARILY CLOSING
Voluntary Opening (VO)
Terminal device CLOSED AT REST
Device can be OPENED BY PROTRACTION of the scapula or FLEXION of the shoulder
RUBBER BANDS on hooks or internal springs/cables in hands offer RESISTIVE FORCE FOR OPENING
RELAXING shoulder muscles allows terminal device to CLOSE
ONE RUBBER BAND provides 1 POUND of pinch force
In order to simulate AVERAGE ADULT PINCH force of 15-20 pounds addition rubber bands added
Voluntary Closing (VC)
Terminal Device is OPEN AT REST
VC device TYPICALLY HEAVIER AND LESS DURABLE than VO device
In order to MAINTAIN CLOSURE of the device to grasp on to the desired object, ACTIVE MUSCLE CONTRACTION REQUIRED
Amputee can get some SENSORY FEEDBACK with this type of terminal device
CLOSING PRESSURE can be as high as 20-25 lbs
Types of Hooks
CANTED
LYRE
Many different styles for different activities
Can be either VO or VC
Objects can be visualized better due to open design
Tougher than hands
Canted Hooks
SIDE approach
OBJECTS MORE VISIBLE when grasping
OBJECT is ROLLED into its GRASP
CANNOT PICK UP SMALL OBJECTS like pins easily
Lyre Shaped Hooks
STRAIGHT Approach
More applicable to bottle or cylindrical shapes
OBJECT is PINCHED
Can PICK UP SMALL OBJECTS EASIER than canted
Terminal Device Hands
Can be both VO or VC
ACTIVE OR PASSIVE
POWERED OR PASSIVE operation
FUNCTION OR AESTHETICS
Location of Northwestern Ring
At HEIGHT OF C7
NO MORE than 1 ‘’ towards SOUND SIDE
Quick Disconnect Wrist PROS
Easy to SWAP terminal devices
More FUNCTION
LOCKING option
Quick Disconnect Wrist CONS
Heavier
More mechanical parts
More costly
Longer build height required
Friction Wrists
LIGHTER
LOWER BUILD HEIGHT
Can be OVAL for COSMESIS
ADJUSTABLE RESISTANCE to pronation/supination
Flexion Radio/Ulnar Deviation Wrist
LOCKABLE at different ANGLES
WEIGHT and BUILD HEIGHT increase
More MECHANICAL parts
Can be used to get TD CLOSER TO MIDLINE
Transhumeral length vs control
Condyles remain, primary control is from humerus
Distal to deltoid insertion, primary control is from humerus assisted by shoulder girdle
Proximal to deltoid insertion, primary control is form the shoulder girdle assisted by the humerus
