UPPER LIMB PROSTHETICS
Dr Deepak Prasad J
Second Year PMR PG Resident
CONTENTS
INTRODUCTION
FUNCTIONAL LEVELS OF AMPUTATIONS
ACUTE MANAGEMENT
UPPER LIMB PROSTHETIC SYSTEMS
SOCKET & SUSPENSION CHOICES
POWER
LEVEL SPECIFIC PROSTHESIS
TERMINAL DEVICES
WRIST UNIT
ADVANCES IN PROSTHETIC TECHNOLOGY
CONCLUSION
INTRODUCTION
Common reasons for amputation – Diabetes, peripheral vascular
disease, trauma, malignancy.
Congenital deficiencies – Genetic variation and Mutation.
FUNCTIONAL LEVELS OF AMPUTATION
Radial amputations involve the thumb
and index finger.
Finger tip amputation – most common
type of amputation.
Thumb – most functionally critical digit.
Thumb amputations – lead to loss of
palmar grip, side-side pinch, and tip-tip
pinch.
Transverse digit amputations – at one
or more digits.
Ulnar amputations – digits 4 & 5 – loss
of hook grasp.
Central amputation – digits 3 & 4.
FUNCTIONAL LEVELS OF AMPUTATION
Trans-radial
Elbow disarticulation
Trans-humeral
Shoulder disarticulation
Forequarter amputation
Wrist disarticulation
Amputations that separate the carpal bones from the radius
and ulna are referred to as wrist disarticulations.
Amputations that occur within the substance of the radius
and ulna are classified as transradial amputations.
When the humerus is preserved but the radius and ulna are
removed, the amputation is referred to as an elbow
disarticulation.
Those that leave more than 30% of humeral length are
designated as transhumeral amputations.
Residual limb length less than 30% of the proximal
humerus is treated like shoulder disarticulation
because of the lack of humeral lever arm.
More proximal amputations that invade the central
body cavity, resecting the clavicle and leading to
derangement of the scapula, are described as
interscapulothoracic (fore-quarter) amputations.
Articulations between the radius and
the ulna along the entire forearm are
necessary to provide for natural anatomic
movements in supination and pronation,
As the level of amputation moves
proximally from the styloid process of
the radius toward the elbow, the ability
to perform and to use pronation and
supination during functional activities is
progressively lost
ACUTE MANAGEMENT – GOALS
Immediate Postamputation Goals
Promote wound healing
Control pain
Control oedema
Prevent contracture
Initiate remobilization and pre-prosthetic training
Manage expectations through supportive counselling
ACUTE MANAGEMENT – POST AMPUTATIONS
Surgical site infection needs to be seriously
considered
Pain control – early, aggressive approach
Residual limb pain & Phantom limb pain
Dressing techniques and Desensitization techniques.
(Help to eliminate hypersensitivity to touch) –
Compression, tapping, massage.
ACUTE MANAGEMENT – POST AMPUTATIONS
USE OF MODALITIES
Transcutaneous nerve stimulation
Heat and cold – for pain control
Mirror therapy
EDEMA CONTROL – immediate postoperative
rigid dressing (IPORD) – removed and replaced
with a fresh cast after 5-7 days.
Attachment of joints & terminal device to this
creates an immediate postoperative prosthesis
(IPOP)
PRE-PROSTHETIC TRAINING
Begins with early postsurgical therapy visit and continues
until prosthetic fitting is completed.
Prosthetic fabrication and fitting - Ideally should be
completed within 4-8weeks after surgery.
Orientation to the planned prosthesis, pre-myoelectric
testing and training.
UPPER LIMB PROSTHETIC SYSTEMS
4 CATEGORIES
PASSIVE SYSTEM – primarily cosmetic
BODY-POWERED SYSTEM
EXTERNALLY POWERED SYSTEM – uses
outside power source such as battery
HYBRID SYSTEM – uses patients own
muscle strength & joint movement as
well as an external power supply.
SOCKET & SUSPENSION CHOICES
Socket – snug and intimate fit around the residual limb.
Flexible, durable, and lightweight, such as a carbon
graphite material or plastic.
Usually double walled with a second lamination pulled
over the first to provide cosmesis and function.
POWER
Body powered Prosthesis – cable controlled
Externally powered prosthesis – electrically powered
Myoelectric prostheses
Switch-controlled prostheses
LEVEL SPECIFIC UPPER LIMB AMPUTATION PROSTHESES
Patient with a partial hand deficiency has 4 prosthetic options:
No prosthetic intervention
A passive prosthesis
A body-powered prosthesis – cable driven and wrist or finger driven
devices.
Multiple task-specific prosthesis
LEVEL SPECIFIC UPPER LIMB AMPUTATION PROSTHESES
Trans-radial socket options
• Self suspending system
• Muenster
• Northwestern
• TRAC – Trans-radial Anatomically contoured
MUENSTER TYPE
Introduced in 1960s for a short trans-radial
level amputation.
Elbow in preflexed position (35deg), and a
channel is provided at the antecubital space for
biceps tendon.
Anterior-posterior compression around the
olecranon.
NORTHWESTERN TYPE
Uses medial-lateral compression of the arm
above the epicondyles and less restrictive
anterior-posterior compression.
Used primarily in those with long residual
limbs.
TRAC – TRANS-RADIAL ANATOMICALLY CONTOURED
TRAC socket uses both anterior-
posterior and medial-lateral
compression for enhanced stability and
comfort.
Transfers the load from distal end of the
radius to the more load-tolerant proximal
musculature.
TRANSRADIAL HARNESS SUSPENSION
FIGURE OF 8 (O –ring)
FIGURE OF 9
FIGURE OF EIGHT HARNESS
The foundation of all body-powered
prostheses is a harnessing system
that provides both a firm anchor
for the control cables and in
some cases a stable means of
suspension.
Most body-powered systems use a
figure-of-eight–style harness
FIGURE OF NINE HARNESS
If the prosthetist recommends a self-
suspending socket, the anterior suspension
strap of a figure-of-eight harness is
unnecessary.
In these instances a figure-of-nine harness,
consisting mainly of the contralateral
axillary loop, is used to minimize
cumbersome harnessing while still maximizing
a firm anchor for the control cable.
TERMINAL DEVICES
ACTIVE DEVICES PASSIVE DEVICES
Hooks including prehensors Functional terminal devices
Artificial hands Cosmetic
Prehensile patterns
Types of Grip
Cylindrical grasp
Prehension grip
Tip grasp
Tripod grip
Hook grasp
Lateral grip
Palmar grasp
Hook power grip
Spherical grasp
Spherical grip
Lateral grasp
WRIST UNIT
Provides orientation of the terminal device in space.
Can be positioned manually, by cable operation, or
with external power.
Once positioned, unit is held in place by a friction
lock or mechanical lock.
Two types – Friction control or locking.
ADVANCES
TARGETED MUSCLE REINNERVATION
BIONIC HAND
REFERENCES
BRADDOM PHYSICAL MEDICINE AND REHABILITATION
ORTHOTICS & PROSTHETICS IN REHABILITATION BY KEVIN K. CHUI
THANK YOU…
