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Above The Elbow Amputations

Above The Elbow Amputations. - Introduction -. Amputation : Missing part or all of a limb. Amputations can be classified into two categories: Congenital or acquired amputation.

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Above The Elbow Amputations

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  1. Above The Elbow Amputations

  2. - Introduction - • Amputation: Missing part or all of a limb. Amputations can be classified into two categories: Congenital or acquired amputation. • Congenital amputation: When an individual is born without a limb. Congenital amputations are classified according to the site or the level of limb absence. • Acquired amputation: When an individual has a limb removed by operation due to trauma, infection, diabetes and/or vascular impairment.

  3. Subjective & Objective Findings Indications: • Peripheral Vascular Disease • Traumatic Injury • Thermal and Electrical Injury • Frostbite • Irreparable loss of the blood supply of a diseased or injured upper extremity is the only absolute indication for amputation regardless of all other circumstances

  4. Subjective & Objective Findings Contraindication: • The only absolute contraindication to amputation is a spared limb or part of a limb that would be functionally superior to its amputation

  5. History of the Procedure • Amputations are one of the oldest surgical procedures • Evolved significantly since days of severing a limb from an unanesthetized patient and dipping the stump in boiling oil to achieve homeostasis • Modern ideas of amputation and prosthetics were not developed until World War I and World War II

  6. Frequency • Unknown the true frequency of acquired amputation at or above the elbow • Published estimates of amputated limbs vary significantly- 350,000-1,000,000 persons with amputations • Annual incidence of 20,000-30,000 persons with new amputations

  7. Post-op Findings • The obvious: Lack of lower part of arm. Potentially wearing prosthetic device already. • Client may present with a cold, pale and likely painful portion of upper arm due to some vascular compromise. • Level of amputation must be determined according to injury or disease. They will try not to compromise too much, save whatever they can to promote prosthetic limb opportunities and padding. • Sense of touch will likely also be compromised due to cutaneous denervation or neuroma development.

  8. Neuroma • Neuroma may develop post surgery at the end of a nerve. • Subject to pressure from the prosthesis socket. • Pain upon weight bearing can be relieved with cortisone injection to area or ultrasonic therapy.

  9. Limb Sensations • Phantom Limb Pain – random sharp shooting pains or spasms, coming in bursts. • Phantom Limb Sensation – feeling of finger twitches, itches or sensation in the missing limb.

  10. Joint Contracture • Potential for joint contracture • Develop with lack of mobility • Important to rehabilitate shoulder region to operate prosthetic or use stump effectively.

  11. Complications • Hematomas • Infections • Necrosis • Neuroma • Phantom sensations • Phantom pain • Deep venous thrombosis • Terminal overgrowth • Bony spurs • Contractures

  12. Care of the Stump • It is recommended you wash your stump at night after taking the prosthesis off.  • Bacteria can build up in sweat, and cause infections. • A few drops of tea tree oil applied to the stump each day can eliminate the odour caused by these • Generally, the longer the residual stump, the greater the residual function with or without a prosthesis • Wearing a prosthesis may correct any imbalance in the upper body

  13. Role of the Kinesiologist: • Role of exercise on above-elbow amputations • Exercises should be performed standing or sitting with feet firmly on floor • Arm amputees must have strong back muscles to help them support an artificial limb and to get the best use from it • Simple back exercises can improve an amputee's comfort and ability to function, and prevent future problems

  14. Role of the Kinesiologist: • Rehabilitation after arm amputation includes: • general conditioning exercises • stretching of the shoulder and elbow • strengthening of the arm muscles • endurance exercises may also be necessary

  15. Didier Germain • Didier Germain- fishing pro for NOPWT won 4 of 6 past NOPWT events and NOPWT championship with Above-Elbow Amputation.

  16. References • Sugarbaker, P., Bickels, J., & Malawer, M. (2001, Feruary 22). Above elbow and below elbow amputations. Retrieved November 20, 2005, from http://www.sarcoma.org/publications/mcs/ch18.pdf • Natarajan, M., & Mayilvahanan, N. Amputations. Retrieved November 20, 2005, from http://www.bonetumour.org/book/Truma/chapter28/CHAP28.html • Edwards, S. (2005, November 14). Elbow and Above Elbow Amputations. Retrieved November 19, 2005. http://www.emedicine.com/orthoped/topic10.htm

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