Amputation 6) Shoulder Disarticulation

- Absence or loss of a part / whole limb - Amputation through glenohumeral joint

Congenital (inborn)
Acheiria
Phocomelia (seal limb)
- Remove shoulder joint
- Scapula is left
7) Forequarter amputation
No hand
- Implies removal of part of scapula, clavicle, and all of
No arm / forearm UE

Amelia No limb (both UE & LE)

Adactylia No digits (inc or lahat wala)

Apodia No foot

Hemimelia Major part is missing

Distal 3rd of limb is absent
No / inc / missing tibia or
fibula

Constricting band Cause is unknown

syndrome Amniotic fluid from fibers in
uterus tie UE that
degenerates

Acquired
1. Vascular disorders
- Most common in LE
- Ex. diabetes (leads to necrosis)
2. Trauma
- Most common in UE
3. Infection
4. Tumor
- Sarcoma
5. Burn
- Thermal insult to body
● Fire
● Frostbite / cold burn
● Electrical burns Lower Extremities
● Chemical burns 1) Toe amputation
- Complete phalangeal amputation
Most common UE amputation = Right transradial 2) Transmetatarsal amputation
Most common LE amputation = transtibial - Partial metatarsal amputation through metatarsal
Males > Females bones
3) Lisfranc’s amputation
LEVELS OF AMPUTATION - Complete metatarsal amputation through
Upper Extremities tarsometatarsal joints
1) Phalangeal amputation - Disarticulation of tarsal & metatarsal
● Interphalangeal disarticulation 4) Chopart disarticulation
● Metacarpophalangeal disarticulation - Partial tarsal amputation through midtarsal joints
2) Wrist disarticulation 5) Boyd’s amputation
- Remove carpals - Horizontal ankle/calcaneal amputation
3) Below elbow (BE) 6) Pigaroff’s amputation
● Short / Very short ➜ 0-35% - Vertical ankle amputation
● Medium / short ➜ 35-55% 7) Syme amputation
● Long ➜ 55-90% - Amputation above ankle
4) Elbow disarticulation - Sometimes includes malleolus
5) Above elbow (AE) 8) Below knee (BK)
● Very short ➜ 0-30% - Partial leg amputation
● Short ➜ 30-50% ● Short ➜ <20%
● Standard ➜ 50-90% ● Standard ➜ 20-50%
● Long ➜ 90-100% ● Long ➜ >50%
9) Knee disarticulation COMPLICATIONS
10) Above knee 1. Edema - lymphatic drainage is severed
● Short ➜ <35% 2. Wound infection
● Middle ➜ 35-60% 3. Pain - residual limb pain
● Supracondylar ➜ >60% a. Post-op pain
11) Hip disarticulation b. Peripheral nerve neuroma
12) Hemipelvectomy c. Prosthetic pain
4. Muscle weakness
5. Muscle tightness & contractures
6. Joint instability
7. Autonomic dysfunction
8. Somatosensory impairment

PHANTOM LIMB
● Phantom limb sensation
- Feeling that amputated limb is still there
● Phantom limb pain
- Feeling that amputated limb is painful
● Suspected that the brain has not moved on from loss

MIRROR THERAPY
- Sensitizing brain (retrain)

Surgical Processes
1. Myoplasty - muscle to muscle
2. Myofascial - muscle to fascia (connective tissue after
skin & before muscle)
3. Myodesis - muscle attached to periosteum (thin
covering of bone)
4. Tenodesis - muscle attached to bone
5. Neuromas - collection of nerve ends (residual limb
pain)

POSTSURGICAL DRESSINGS

KNEE AMPUTATION
a. Tenoplastic
- Cut on supracondylar of femur
- Quads tendon
b. Osteoplastic
- Cut on supracondylar of femur
- Patellar bone fixation
Guillotine Amputation
- Open amputation
- Has an active infection
Assessment
● Patient history
Questions:
1. Occupation
2. Present medical history
3. Date of amputation
4. Amputation complication
5. Prosthesis fift & function
6. Stump care
7. Pain or abnormal sensation
- Phantom limb (needs to work w/ psychiatrist)
OBSERVATION
● Stump - look at weight bearing areas INTERVENTION
● Prosthesis ● Positioning to avoid contractures
● Balance ● Standing balance & transfer activities
● Gait ● Mobility training w/ crutches or walker
● Residual limb care & protection; bandaging if
EXAMINATION appropriate (DESENSITIZATION - give sensory
1. Active movement stimulation so brain will learn that it’s amputated)
2. Passive movement ● Care of the remaining LE (if circulation is
3. Resisted isometric movement compromised)
4. Functional assessment ● Education on amputation & prosthesis
5. Sensation testing
6. Psychological testing
7. Palpation
8. Diagnostic imaging