Limb loss is a major, life-changing event and not everyone has access or knows about the options available. Especially when it comes to upper-extremity amputees.
When we talk about prosthetic solutions, it’s common to think about the lower extremities. But we can’t forget those with upper-extremity amputations, as they can be just as complex. As we have learned from a previous blog post, there are many components that make up a prosthesis. Generally, the higher the level of amputation, the more components are used. But it helps to better understand these types of amputations.
The Types of Upper Extremity Amputations
The levels of amputation for upper extremity are classified as:
- Digit/finger (further divided by the level at which the amputation occurs on the phalanges)
- Partial hand
- Wrist disarticulation
- Transradial/below elbow or between the elbow and the wrist
- Transhumeral/above elbow or between the shoulder and elbow
- Shoulder disarticulation
- Forequarter amputation
Though there are a plethora of types of upper-extremity amputations, there are also prosthetic solutions specifically designed for each.
The above-elbow prosthesis comprises of a socket that is fit to the patient’s residual limb. Harnesses are used for suspension and to control the prosthetic attachment (a prosthetic hook or hand) attached at the distal end of the limb. The prosthetist will guide the patient on body mechanics to control their prosthetic elbow, wrist and prosthetic attachment.
Similar to the above elbow prosthesis, this level requires a socket that is fit to the patient’s residual limb. Suspension is achieved through the use of harnesses or suction. The prosthetic attachment can be controlled through body mechanics or myoelectric sensors.
The myoelectric system uses antagonist muscle electrical signals to control the prosthetic attachment. One sensor is strategically placed on the skin surface of the extensor muscle, and another on the flexor muscle. The patient can fire the extensor muscle and open the prosthetic attachment; and likewise by firing the flexor muscle, the patient can close the prosthetic attachment.
Partial Hand and Digits Solutions
These functional hand prostheses are available in four different types:
- The PIPDriver (fig. E) provides a solution for an amputation that goes through the middle phalanx.
- The MCPDriver (fig. D, E) is suitable for an amputee who has lost the distal 2/3 of their finger(s).
- The ThumbDriver (fig. D, E), as its name implies, restores the length and opposition for a missing thumb.
- The GripLock Finger (fig.G) is for someone who has lost all of their fingers.
These prostheses are ideal for partial-hand amputees. The digits are easily adjustable through a ratcheting mechanism to match the desired grasps and positioning, and with a push of a button quickly release the grasp. Figure C1 shows that the patient is able to hold a foam ball with the use of the prosthesis.
This option uses myoelectric signals to control the hand. A couple of sites are strategically located to place the sensors, which will send signals back in the computerized component according to the grip patterns chosen. A custom silicone socket lines the carbon socket for suspension and added comfort. (Fig. C)
A silicone restoration is a passive prosthesis that is custom-made to match the patient’s sound side. The primary benefit of this type of prosthesis is to protect the residual limb. Moreover, a silicone restoration will provide support with pushing, pulling, and stabilizing functions. (Fig. F)
As clinicians for our patients, it is our responsibility to provide the best care and options to our patients and guide them through the process for prosthetic management. Understanding the benefits and drawbacks of the devices and matching the patient with the right one based on their individual goals is the path to success.
“Although there are some who learn to adapt and achieve some functional independence without a prosthesis, there are numerous reports highlighting the benefits of consistent prosthesis use.” (Graham et al, 2020). Pre-amputation consultation with a prosthetist and PT/OT team plays a great role in mapping out the steps and providing education for the patient.
As you can see, there are multiple solutions for every type of upper-extremity amputation. Tillges are your Partners for Life – contact our team today and we will create the solution that meets your specific needs and goals.
- Graham, Emily; Hendrycks, Russell; Baschuk, Christopher; Atkins, Diane; Keizer, Lana; Duncan, Christopher; Mendenhall, Shaun. “Restoring form and function to the partial hand amputee: prosthetic options from the fingertip to the palm.” Hand Clin, vol. 37, 2020, pp. 167-187 https://www.sciencedirect.com/science/article/abs/pii/S0749071220301232?via%3Dihub
- Ovadia, Steven; Askari, Morad. “Upper extremity amputations and prosthetics.” Seminars in Plastic Surgery, 2015; 29(01): 055-061