Upper limb prosthesis in Upper limb prosthesis in PPPP

Trans humeral amputation Trans humeral amputation

Measurements, Cast and Measurements, Cast and RectificationRectification

1) Patient 1) Patient ExaminationExamination

Check the passive and Check the passive and active range of movement active range of movement of the gléno-humeral joint.of the gléno-humeral joint.

Make a muscle testing.Make a muscle testing.

Check that the patient is Check that the patient is able to operate straps and able to operate straps and fastenings. ( sound upper fastenings. ( sound upper limb)limb)

Check for any painful areasCheck for any painful areas

2) Measurements : sound side2) Measurements : sound side Axilla or acromion process to Axilla or acromion process to

olecranon with elbow flexed.olecranon with elbow flexed.

Axilla or acromion process to Axilla or acromion process to thumb tip with elbow straight. thumb tip with elbow straight.

Hand size, for cosmetic reasons, Hand size, for cosmetic reasons, the prosthetic hand should be the prosthetic hand should be slightly smaller than the sound slightly smaller than the sound hand. hand.

Show the patient a selection of Show the patient a selection of suitable hands and hooks prior to suitable hands and hooks prior to the casting stage.the casting stage.

Measurement: amputated sideMeasurement: amputated side

Axilla or acromion process Axilla or acromion process to end of stump.to end of stump.

Stump circumferences.Stump circumferences.

if required on an elbow if required on an elbow disarticulation patient, disarticulation patient,

ML measures at and ML measures at and above epicondyles.above epicondyles.

Measurement chartMeasurement chart

Socket designSocket design

1) The proximal trim line of the socket passes1) The proximal trim line of the socket passes over the top of the shoulder girdle.over the top of the shoulder girdle.

2) The socket is trimmed below the top 2) The socket is trimmed below the top

of the shoulder girdle.of the shoulder girdle.

Socket designSocket design

= some weight is taken over = some weight is taken over the shoulder thus reducing e the shoulder thus reducing e the load on the harness.the load on the harness.

it limits the amount of it limits the amount of shoulder abduction.shoulder abduction.

1) The proximal trim line of the socket passes1) The proximal trim line of the socket passes over the top of the shoulder girdle.over the top of the shoulder girdle.

Socket designSocket design

Its allows a greater range of Its allows a greater range of abduction but places a higher abduction but places a higher

load on the harnessload on the harness

2) The socket is trimmed below the top 2) The socket is trimmed below the top

of the shoulder girdle.of the shoulder girdle.

Socket designSocket design

Both designs rely on anterior and posterior wings Both designs rely on anterior and posterior wings which extend medially to the line drawn down which extend medially to the line drawn down through the axilla.through the axilla.

Any gapping of the wings reduces their Any gapping of the wings reduces their effectiveness.effectiveness.

Before casting , the P&O has to decide which type of socket will be manufactured.

Cast technique Cast technique

A thin casting stockinet is put A thin casting stockinet is put onto the stump.onto the stump.

Mark any painful or bony areas.Mark any painful or bony areas.

Mark the shoulder girdle's bony Mark the shoulder girdle's bony prominences as clavicle & prominences as clavicle & acromion process.acromion process.

Draw the trim lines on the Draw the trim lines on the stockinet.stockinet.

Apply pressure on top of the pectoral Apply pressure on top of the pectoral muscles just below the clavicle. muscles just below the clavicle.

Cast techniqueCast technique

Apply proper and even Apply proper and even tension of POP bandages tension of POP bandages during casting.during casting.

Cast irregularities make Cast irregularities make the removal of the cast the removal of the cast more difficult.more difficult.

Cast technique: slab castCast technique: slab cast

1.1. one slab for axilla ( 6 layers)one slab for axilla ( 6 layers)

2.2. one slab for the medial wallone slab for the medial wall

3.3. one slab for the anteriorone slab for the anterior

4.4. one slab for the posteriorone slab for the posterior

5.5. one slab for the lateral and one slab for the lateral and shoulder shoulder

Each slab is composed of 3 layers of POP bandage Each slab is composed of 3 layers of POP bandage

( width 15cm).( width 15cm).

6. a roll of POP bandage ( 10 cm) is connecting the slabs together

Cast technique : slab castCast technique : slab cast Each slab should be slightly Each slab should be slightly

longer than the stump.longer than the stump.

The axilla slab has to be 3 times The axilla slab has to be 3 times the length of the axilla.the length of the axilla.

Start casting by positioning the Start casting by positioning the axilla slab in order to shape the axilla slab in order to shape the medial trim line.medial trim line.

Then position the medial slab : Then position the medial slab : this slab has to overlap the axilla this slab has to overlap the axilla slab.slab.

During casting, beware of stump abduction.During casting, beware of stump abduction.

Cast technique : slab castCast technique : slab cast

The shoulder slab should reach The shoulder slab should reach from anterior axilla area to from anterior axilla area to posterior axilla area.posterior axilla area.

In order to flatten the medial wall, In order to flatten the medial wall,

the patient is keeping the stump the patient is keeping the stump against the trunk (ribcage).against the trunk (ribcage).

The sub-clavicular fossa and the The sub-clavicular fossa and the clavicle need to be well shaped.clavicle need to be well shaped.

Cast technique: slab castCast technique: slab cast

The cast is removed while the POP bandages The cast is removed while the POP bandages have set. have set.

Draw and cut the trim lines.Draw and cut the trim lines.

For an "over the shoulder socket design",For an "over the shoulder socket design", the medial trim line is cut straight above the the medial trim line is cut straight above the

edge of the axilla.edge of the axilla.

It allows a good suspension and abduction.It allows a good suspension and abduction.

Plaster socket fittingPlaster socket fitting

Ensure that the Ensure that the patient can flex and patient can flex and extend stump without extend stump without rubbing at medial trim rubbing at medial trim line level.line level.

For long stump the For long stump the medial wall can be medial wall can be lowered ( 1 cm).lowered ( 1 cm).

Plaster check socketPlaster check socket

The "wings" should The "wings" should not be wider than half not be wider than half of the distance from of the distance from the axilla to the corner the axilla to the corner of the neckof the neck

Alignment of the negative cast Alignment of the negative cast

Lateral and anterior Lateral and anterior alignement build down line alignement build down line should be marked.should be marked.

For short stumps (abducted) For short stumps (abducted) we can use modified build we can use modified build down linedown line

Rectification of the positive castRectification of the positive cast

Minimal rectification is Minimal rectification is neededneeded

Ensure that marks and build Ensure that marks and build down lines are transferred down lines are transferred to the castto the cast

The distal end does not The distal end does not usually need a build-upusually need a build-up

Rectification of the positive cast Rectification of the positive cast

Ensure that the medial wall has Ensure that the medial wall has been slightly flattened during been slightly flattened during the casting process.the casting process.

This allows the arm to adduct This allows the arm to adduct comfortably against the rib cagecomfortably against the rib cage

Rectification of the positive cast Rectification of the positive cast

All production measures are taken All production measures are taken fromfrom the medial trim line at the the medial trim line at the axilla.axilla.

If this trim line is lowered in the If this trim line is lowered in the case of a patient with a long stump, case of a patient with a long stump, the amount lowered should be the amount lowered should be noted as it will affect the production noted as it will affect the production measurements.measurements.

Rectification of the positive castRectification of the positive cast

The wings should be smoothened, The wings should be smoothened, ensure that the edges flare slightly ensure that the edges flare slightly outwards slightly to prevent them outwards slightly to prevent them digging into the body.digging into the body.

The acromion and clavicle will need The acromion and clavicle will need built upbuilt up