Upper Extremity Amputations

- See:
      - Amputation of the Finger and Hand:
      - Above-Elbow Amputation
      - Below-Elbow Amputation
      - Upper Extremity Prosthetics:
      - Wrist Disarticulations

- General Considerations:
    - Disability:
         - loss of one upper extremity   = 50%
         - loss of one hand                     = 45%
         - thumb amputations                 = 23% (50% of one hand)

- Complications:
neuroma formation:
        - A new operation for the prevention and treatment of amputation neuromas.

- Considerations w/ Brachial Plexus Injuries:
    - w/ fully flail arm, w/o scapulothoracic control, is a candidate for AE amputation;
    - this disencumbers the patient and the reduction of wt reduces the subluxation of the shoulder;
    - w/ one normal arm, the patient will not use a 2 joint AE prosthesis, therefore recommend shoulder fusion, with pectoral muscle transfer to control elbow and BE amputation;
    - there must be scapulothoracic control, not a completely flail extremity;
    - if remaining arm is the dominant arm, and the invovled arm has no scapulo-thoracic contnrol, the patient is not likely to use any prosthesis;
          - AE amputataion relieves shoulder distraction;
          - fusion is pointless if there will be no forward hand placement;

- Upper Extremity Amputations in Children:
    - most children with shoulder level or above-elbow amputations function very well w/o a prosthesis if they have normal contralateral upper extremity;
    - transverse absences of forearm:
         - usually do not mandate excision of nubbins for prosthetic fit;
         - bilateral amputees may be candidates for Krukenberg procedure, where radius & ulna are separated to serve as pincers;
    - children with a below elbow amputation may or may not choose to wear a prosthesis;
         - it used to be taught that early fit of a passive mitten or hand at 6 months of age would encourage integration of the prosthesis into activities of
               daily living, however, this is not seen clinically;
         - these children may note that the prosthesis may be hot and sweaty in the summer and have a negative effect on proprioception;
    - at approximately 2 years of age, a functional terminal device can be added if it is requested by the child or parent

Myoelectric prostheses. A long-term follow-up and a study of the use of alternate prostheses.

The surgery of arm and forearm amputations.  

A new approach to the use of the Krukenberg procedure in unilateral wrist amputations. An original functional-cosmetic prosthesis.

Upper limb amputations and prostheses.

The rational selection of treatment for upper extremity amputations.    

Grabbing Gracefully, With Replacement Fingers

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, May 11, 2012 1:40 pm