Arm Prosthetics & Upper Limb Prosthesis
An amputation is the removal of a limb as a result of surgical intervention, trauma or a disease process. The loss of a limb can be physically and emotionally challenging for the patient and others. In general, most amputees resume their normal activity level with the appropriate prosthetic training and care.
Ten percent of all amputations involve upper extremities. There are various reasons for the loss of upper limb such as a traumatic accident, disease process and congenital anomaly. The most common reason for upper limb loss is trauma.
It is important to know you are not alone in your rehabilitation process as an individual with an amputation. The amputation rate is rising in the United States, mainly due to vascular disease and diabetes. Currently it is estimated 1.9 million people are living with a limb loss. This is equivalent to one out of every 200 individuals.
There is much to consider as an upper extremity prosthetic candidate. The loss of a limb brings many emotions and questions to mind. Many factors drive an amputee's readiness for a prosthesis. The patient must have a strong desire to be active again, a certain level of physical fitness, and a well healed amputation site. One of the most important steps in being a successful prosthetic user is to recognize the need for a good support team. Your team should include family, friends, and medical professionals, such as our caring and certified staff at "Centers for Mobility".
"Centers for Mobility" provides complimentary pre-amputation consultations. It is important to seek information prior to your surgery. This helps reduce fear, answer your questions, and inform you of what to expect after surgery. Pre-surgical consultations are performed at one of our three certified facilities, at your hospital bedside or in the comfort of your home.
Preparing Yourself for Your Prosthesis
After your amputation, the ultimate goal in preparing your residual limb for a prosthesis is to reduce swelling by stabilizing the size and shape of the amputated limb. Swelling after surgery is normal. With your physician's order, your prosthetist may begin to address your swelling. This is achieved by compression and elevation of the limb.
A "prosthetic shrinker" helps control swelling by providing compression over the amputated limb. A shrinker is made from an elastic material and is applied directly over the residual limb. Another way to control swelling is by wrapping the limb with an "Ace" elastic bandage. Your prosthetist will demonstrate their proper application.
Another important factor in preparing your limb for a prosthesis is to work towards healing your surgery site. This may be achieved by keeping the surgical site clean, following your physician's instructions and avoiding injuries. In general, sutures/staples are removed with 10-21 days after surgery. Keep in mind, each individual is different.
Evaluation and Casting
Once your residual limb is healed, your prosthetist performs an evaluation. This consists of a discussion of your personal goals, patient's expectations and prosthetist's recommendations. During this visit, a plaster impression and measurements of your residual limb are taken. These are used for the fabrication of your test socket.
Test or Check Socket Fitting
A "test socket" is a transparent positive plastic model of the residual limb. During your visit, you will wear the socket and the practitioner evaluates the fit. This is a diagnostic tool to address any fitting issues and modifications needed to achieve a comfortable and proper fit. The "test socket" is also used to fabricate your "preparatory or definitive prosthesis". Typically, it is necessary to make more than one "test socket".
A "preparatory prosthesis" is an unfinished functional replacement for an amputated limb. It is usually worn for several weeks to months by an individual with a new amputation. Wearing this socket will expedite the rehabilitation process and allows your residual limb to stabilize in volume and shape. Your prosthetist determines when you are ready for a "definitive or permanent prosthesis".
The "definitive prosthesis" is meant for long term use. This prosthesis consists of components based on your activity level. If the patient desires, a cosmetic cover is used to give a more contoured and natural appearance. "Centers for Mobility" recommends physical therapy for all new amputees. This is an important step in learning how to properly use your new prosthesis and in becoming a successful prosthetic user.
Follow Up & Maintenance of the Prosthesis
After the delivery of your "definitive" prosthesis, the prosthetist requests the patient to set up an appointment for a three week follow up. During the follow up, the practitioner will address issues the patient may have encountered.
Over time the patient may experience a change in the fit, residual limb, alignment or physical condition of the prosthesis. The patient should contact their prosthetist if this occurs.
Upper Extremity Prosthetic Parts
Upper extremity prosthesis consists of several main components:
- Socket- made from a plastic and fits over the residual limb
- Control Cable System- opens/closes terminal device and or elbow
- Terminal Device- a variety of terminal devices such as a hand, hook, or an activity specific tool (knife, hammer) is available based on your prosthetic needs; each is used to grasp, grip and perform bimanual tasks
- Suspension system- a variety of suspension systems such as a harness, locking pin or suction is available based on your prosthetic needs; each is used to hold the prosthesis securely to the residual limb
- Interface- a variety of interfaces such as socks, silicone sheaths, gel or silicone liner with locking pin is available; each is used for cushioning and protection
- Wrist and/or Elbow Unit- a variety of wrist and/or elbow units is available based on your prosthetic needs; allows rotation and/or flexion of the terminal device
Types of Upper Extremity Prostheses: Body Powered, Electric Powered, or Cosmetic
A body powered prosthesis contains straps and cables which allow you to close/open the hand or bend the elbow by moving your shoulders. Typically, a hook is used for the terminal device.
An electric powered prosthesis allows you to flex your muscles inside of the socket to stimulate an electrode. Once the electrode is stimulated, your hand will open/close.
A cosmetic arm is made simply for aesthetic purposes. The hand generally does not move, but is somewhat useful for holding items down.
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