Upper Limb

Amputation
Introduction

• Amputations is the surgical removal of a part of the body, a

limb or part of a limb

• Amputations are performed to remove limbs that are no

longer functional because of injury or disease

• common reasons: diabetes, peripheral vascular disease,

trauma, congenital, and malignancy.

Cifu, D.X., 2015. Braddom's physical medicine and rehabilitation. Elsevier Health Sciences.
Upper limb loss is more
commonly caused by
trauma than lower limb
loss.

Trauma accounts for 90%

of all upper limb
amputations
Terminology
• The residual limb refers to the remaining part
of the amputated limb.
• The sound limb refers to the non amputated
limb.
Classifiction Upper Limb Amputation
• involves digits III & IV, and reconstruction is usually
amputation
not attempted, and a cosmetic substitute is used. Central
amputations
• involve digits IV & V, and hook grasp is lost. Ulnar
amputation
• is the most common type of amputation. Fingertip
• involve the thumb & index finger & compromise
amputations
grasp. Radial
1. Hand Amputation
Thumb Amputation

The thumb
Amputation of
Loss of palmer
Thumb one of the
the most grip, side-to-
amputation, other digits
functionally side pinch, &
partial or causes lesser
critical digit. tip-to-tip
complete. functional
pinch.
loss.
Wrist disarticulations
• preferred over more proximal amputations
because maximal pronation and supination are
preserved.
• removal of the radius and ulna to the styloid
processes,
• retains the distal radialulnar joint, preserving
forearm rotation.
• The prosthetic attachment to the bulbous end
is enhanced if the distal radial flare is retained
for suspension.
Complicated with difficult
socket fabrication
• conventional wrist units are
too long & cannot be used
• it is harder to fit with a
myoelectric prosthesis
because there is no room to
conceal the electronics and
power supply.
 • 0% to 35% preservation
• difficult prosthetic suspension
short
• loss of full ROM at the elbow.
• preserves 35% to 55% length
• pronation and supination with a prosthesis are
lost.
medium
• Elbow flexion is reduced because of the
inhibiting prosthesis.
• amputation preserves 55% to 90% length,
• allows up to 60 degrees of supination & long
pronation with a prosthesis
• strong elbow flexion.
3. Transradial amputations
4. The elbow disarticulation
 • 0% to 35% preservation
• difficult prosthetic suspension
short
• loss of full ROM at the elbow.
preserves 35% to 55% length
pronation and supination with a prosthesis are
lost.
medium
Elbow flexion is reduced because of the
inhibiting prosthesis.
utation preserves 55% to 90% length,
s up to 60 degrees of supination & long
ation with a prosthesis
g elbow flexion.
5. The transhumeral amputation
 6. Shoulder disarticulation and
forequarter amputations
– the most difficult to fit with a functional
prosthesis, due to the number of joints to be
replaced and the problems related in maintaining
secure suspension of the prosthesis
– Special consideration should be made for
providing a shoulder cap to allow the patient to
wear clothing more easily and improve cosmesis.
– The use of an ultralight passive prosthesis is
usually well accepted in these patients.
• Shoulder
Disarticulation
Forequarter Amputation
 Acute Management
• Pre amputation • Post amputation
 Referrences
• Cuccurullo, S. Physical Medicine and
Rehabilitation Board Review. 2004.
• Uustal, H. Frontera, W. R. DeLisa, J. A. DeLisa’s
Physical Medicine and Rehabilitation
Principles and Practices. 5th edition. 2010.
• Cifu, D.X., 2015. Braddom's physical medicine
and rehabilitation. Elsevier Health Sciences.
Thank
you