Week 11 - OT Management of Upper Limb Amputation

Question 1

why is the prevalence of UE amputations increasing. (name 2 reasons)

Answer 1

• diabetes epidemic

- risk of limb loss increases with age (greater risk after age 65)

Question 2

what is the leading cause of UE amputations?

Answer 2

trauma

Question 3

when would amputation be preferred over replanation?

Answer 3

• mangled/severely crushed extremity

- severe brachial plexus injury with insensate hand/arm - amputation with prosthesis may be more functional

Question 4

name 2 causes of amputation that occur more in lower limbs than upper limbs.

Answer 4

• ischemia

- infection

Question 5

a rare bacterial infection that spreads quickly in the body and can cause death. accurate diagnosis, rapid antibiotic treatment, and prompt surgery are important to stopping this infection

Answer 5

necrotizing fascitis

Question 6

name the 2 categories of pediatric amputations.

Answer 6

• congenital

- acquired

Question 7

what percent of congenital limb deficiencies are UE?

Answer 7

58%

Question 8

T/F - terminology for congenital amputations is not the same as acquired amputations.

Answer 8

true

Question 9

disarticulation, forequarter, inter-scapulothoracic

Answer 9

shoulder

Question 10

trans-humeral

Answer 10

above elbow

Question 11

disarticulation

Answer 11

elbow & wrist

Question 12

trans-radial

Answer 12

forearm

Question 13

partial hand (through metacarpals)

Answer 13

hand

Question 14

what is the level of amputation defined by?

Answer 14

the length of the residual limb relative to the non-injured limb

Question 15

OT can help during pre-prosthetic training through ___ ___ on process of preparing residual limb for prosthesis.

Answer 15

patient education

Question 16

what is involved in the post-operative care/pre-prosthetic phase? (name 9)

Answer 16

• shaping and shrinking of residual limb after stitches are removed.
• posture training
• desensitization
• scar management
• ROM - critical to maintain full ROM in remaining joints
• pain management
• strengthening of UEs
• conditioning and endurance training
• ADL training

Question 17

how should residual limbs be wrapped?

Answer 17

always distal to proximal with DECREASING amount of pressure as you move proximally

Question 18

how often must residual limbs be re-wrapped?

Answer 18

every 4 hours

Question 19

in trans-humeral amputations it is crucial to maintain full ROM of which movements?

Answer 19

shoulder IR and ER

Question 20

name 2 methods for pain management.

Answer 20

• TENS

- high-volt pulsed galvanic stimulation

Question 21

how often should mirror therapy take place?

Answer 21

15 mins 5x each day for 1 month

Question 22

when should strengthening of residual limb start?

Answer 22

once surgeon gives ok; must be sufficient healing that resistance with be safe

Question 23

name 3 critical components of pre-prosthetic care for bilateral amputation.

Answer 23

• provide some sense in independence asap
• pts. must use whole body during ADLs ex: objects held btwn residual limb and body
• adaptation for ADL and equipment vital for gaining independence

Question 24

lack of blood supply

Answer 24

ischemia

Question 25

bacterial infection

Answer 25

necrotizing fascitis

Question 26

name the 3 different types of malignancies that can cause UL amputations.

Answer 26

• chondrosarcoma
• ewing’s sarcoma
• osteosarcoma

Question 27

comes outside the bone, can appear in young children

Answer 27

ewing’s sarcoma

Question 28

what is a forequarter amputation?

Answer 28

1/2 the scapula and the entire arm

Question 29

compression is used in scar management for what?

Answer 29

to flatten the scar

Question 30

why are silicone gel pads used in scar management?

Answer 30

helps the scar heal

Question 31

why is massage used for scar management?

Answer 31

helps desensitize and moves scar around so it doesn’t stick

Question 32

phantom limb syndrome is mostly seen in which types of amputations?

Answer 32

finger amputations

Question 33

receptors go over muscles for activation; we have to help train the muscles.

Answer 33

myoelectric prosthesis

Question 34

can be voluntarily opening or closing (most people want opening but it depends)

Answer 34

hook

Question 35

if children don’t receive prostheses in how many months for congenital amputations they may reject it.

Answer 35

6 months

Question 36

name one of the most functional body power prostheses.

Answer 36

split hook

Question 37

you need to have a ___ to operate 3d printed prostheses because they operate on tenodesis.

Answer 37

wrist

Question 38

use of ___ to decrease incisional and phantom pain in conjuction with pain medication.

Answer 38

TENS