Amputations and Prosthetics

Question 1

Forequarter (scapulothoracic)

Answer 1

removal of UE including the shoulder girdle

• lost of shoulder, elbow and hand function
• most common cause is malignancy
• functional prosthetic use is common
• a lightweight cosmetic prosthetic is typically well tolerated

Question 2

Shoulder disarticulation

Answer 2

removal of UE through shoulder joint

• loss of all shoulder, elbow, and hand function
• most commonly the result of malignancy or severe electrical injuries
• functional prosthetic use is possible
• an external prosthetic shoulder joint is typically required

Question 3

transhumeral

Answer 3

removal of UE proximal to elbow

• loss of elbow and hand function
• most commonly due to trauma
• typically 7-10 centimeters proximal to the distal humeral condyles
• trauma associated fracture, dislocation or peripheral nerve injury may delay prosthetic interventions

Question 4

elbow disarticulation

Answer 4

removal of lower arm and hand through elbow joint

• loss of all elbow and hand function
• most commonly due to trauma
• allows for self-suspending socket
• an external prosthetic elbow joint is typically required

Question 5

transradial

Answer 5

removal of UE distal to the elbow

• loss of all hand function
• must be a minimum of five centimeters proximal to the distal radius
• typically the result of trauma
• trauma associated fracture, dislocation, or peripheral nerve injury may delay prosthetic interventions
• functionally preferred over wrist disarticulation or selected partial hand amputations
• most common UE amputation

Question 6

wrist disarticulation

Answer 6

removal of hand through wrist joint

• loss of all hand function
• relatively uncommon level of amputation
• cosmetic and functional prosthetic disadvantage

Question 7

partial hand

Answer 7

removal of portion of hand and digits at either the transcarpal, transmetacarpal, or transphalangeal level

• loss of a portion of digit/hand function
• limb sparing technique utilized when functional pinch can be perserved
• toe transfer to replace a thumb may be considered if prosthesis fails

Question 8

digit amputation

Answer 8

removal of digit at MCP, proximal interphalangeal or distal interphalangeal level

• preserved function is highly variable depending on number of digits involved
• prostheses are not typically used
• a long transradial amputation may be more functional if multiple digits are involved at proximal levels

Question 9

hemicorporectomy

Answer 9

removal of pelvis and both LE

Question 10

hemipelvectomy

Answer 10

removal of one half of the pelvis and the LE

Question 11

hip disarticulation

Answer 11

removal of the LE from the pelvis

• all functions of the hip, knee, ankle, and foot are absent
• most common cause is malignancy
• does not allow for activation of the prosthesis through a residual limb
• prosthetic limb advancement initiated through use of pelvis

Question 12

transfemoral

Answer 12

removal of the LE above the knee

• length of the residual limb with regard to leverage and energy expenditure
• knee componentry will determine ability to functionally reciprocate gait
• stance control may not activate until weight bearing occurs through limb
• donning can be more difficult than with a transtibial amputation
• weight bearing through the ischium in an ischial containment socket
• susceptible to hip flexion contracture
• adaptation required for balance, weight of prosthesis, and energy expenditure

Question 13

knee disarticulation

Answer 13

removal of the LE through the knee joint

• loss of all knee, ankle, and foot function
• residual limb can weight bear through its end
• susceptible to hip flexion contracture
• knee axis of the prosthesis is below natural axis of the knee
• gait deviations can occur secondary to the malalignment of the knee axis

Question 14

transtibial

Answer 14

removal of the LE below the knee joint

• loss of active foot and ankle motions
• weight bearing in the prosthesis should be distributed over the total residual limb
• areas of primary weight bearing should be pressure tolerant
• adaptations required for balance
• susceptible to both knee and hip flexion contracture

Question 15

Symes

Answer 15

removal of the foot at the ankle joint with removal of the malleoli

• loss of all foot function
• residual limb can bear weight through its end
• residual limb is bulbous with a non- cosmetic appearance
• dog ears must be reduced for proper prosthetic fit
• adaptation required for increased weight of the prosthesis
• adaptation required due to diminished toe off during gait

Question 16

transverse tarsal (Choparts)

Answer 16

removal through the talonavicular and calcaneocuboid joints. preserves the PF but sacrifices the DF resulting in equinus contracture

• loss of forefoot leverage
• loss of balance
• loss of weight bearing surface
• loss of proprioception
• tendency to develop equinus deformity

Question 17

tarsometatarsal (lisfranc)

Answer 17

removal of the metatarsals. preserves the PF and DF

• loss of forefoot leverage
• loss of balance
• loss of weight bearing surface
• loss of proprioception
• tendency to develop equinus deformity

Question 18

Rigid dressing advantages

Answer 18

• allows for early ambulation with pylon
• promotes circulation and healing
• stimulates proprioception
• provides protection
• provides soft tissue support
• limits edema
• ability to utilize an immediate post-op prosthesis

Question 19

rigid dressing disadvantages

Answer 19

• immediate wound inspection is not possible
• does not allow for daily dressing change
• requires professional application

Question 20

semi-rigid dressing advantages (unna)

Answer 20

• reduces post op edema
• provides soft tissue support
• allows for earlier ambulation
• provides protection
• easily changeable

Question 21

semi-rigid dressing disadvantages

Answer 21

• does not protect as well as rigid
• requires more changing than rigid
• may loosen and allow for developmental edema

Question 22

NWB rigid removable limb protectors advantages

Answer 22

• removable
• accommodates edema fluctuation
• easily applies
• prevents contracture
• provides protection

Question 23

NWB rigid removable limb protectors disadvantage

Answer 23

not for ambulatory purposes

Question 24

Soft dressing advantages

Answer 24

• reduces post-op edema
• provides some protection
• relatively inexpensive
• easily removed for wound inspection
• allows for AROM

Question 25

Soft dressing disadvantages

Answer 25

- tissue healing is interrupted by frequent dressing changes - joint ROM may delay healing of incision - less control of residual limb - cannot control the amount of tension on bandage - risk of tourniquet effect - shrinker cannot be applied until sutures are removed

Question 26

Common contractures

Answer 26

transmetatarsal and symes- equinus deformity transtibial- knee flexion transfemoral- hip flexion and abduction

Question 27

Hypersensitivity interventions

Answer 27

weight bearing, massage, tapping, residual limb wrapping

Question 28

neuroma

Answer 28

a bundle of nerve endings that group together and can produce pain due to scar tissue, pressure from the prosthesis, or tension on the residual limb

Question 29

Phantom pain treatment

Answer 29

TENS, ultrasound, icing, mirror therapy, relaxation techniques, desensitization, prosthetic use

Question 30

Prosthetic causes of lateral bending

Answer 30

- prosthesis too short - improperly shaped lateral wall - high medial wall - prosthesis aligned in abduction

Question 31

Amputee causes of lateral bending

Answer 31

- poor balance - abduction contacture - improper training - weak hip abductors on prosthetic side - hypersensitive and painful residual limb

Question 32

prosthetic causes of abducted gait

Answer 32

- prosthesis to long - high medial wall - poorly shaped lateral wall - prosthesis positioned in abduction - inadequate suspension - excessive knee friction

Question 33

amputee causes of abducted gait

Answer 33

- abduction contracture - improper training - adductor roll - weak hip flexors and adductors - pain over lateral residual limb

Question 34

prosthetic causes of circumducted gait

Answer 34

- prosthesis too long - excessive knee friction - socket too small - excessive plantar flexion

Question 35

amputee causes of circumducted gait

Answer 35

- abduction contracture - improper training - weak hip flexors - lacks confidence to flex the knee - painful anterior distal residual limb - inability to initiate prosthetic knee flexion

Question 36

prosthetic causes of excessive knee flexion during stance

Answer 36

- socket set forward in relation to foot - excessive dorsiflexion - stiff heel - prosthesis too long

Question 37

amputee causes of excessive knee flexion during stance

Answer 37

- knee flexion contracture - hip flexion contracture - pain anteriorly in residual limb - decrease in quad strength - poor balance

Question 38

prosthetic causes of vaulting

Answer 38

- prosthesis too long - inadequate socket suspension - excessive alignment stability - excessive PF

Question 39

amputee causes of vaulting

Answer 39

- poor muscle control - improper training - weak medial rotators - short residual limb

Question 40

prosthetic causes of forward trunk flexion

Answer 40

- socket too long - poor suspension - knee instability

Question 41

amputee causes of forward trunk flexion

Answer 41

- hip flexion contracture - weak hip extensors - pain with ischial weight bearing - inability to initiate prosthetic knee flexion

Question 42

prosthetic causes of medial or lateral whip

Answer 42

- excessive rotation of the knee - tight socket fit - vagus in the prosthetic knee - improper alignment of the toe break

Question 43

amputee causes of medial or lateral whip

Answer 43

- improper training - weak hip rotators - knee instability