Amputation is a medical term used to describe the loss of a body part usually through trauma or surgical removal. During the amputation of an arm the surgeon may remove the limb at any place below the shoulder. The goal is to leave enough skin flap to cover the stump and enough bone either above the elbow or below the elbow in order to allow an appliance to be used. The surgeon will attempt to retain the head of the bone in order to preserve the shape of the shoulder and retain an attachment of the muscles of the shoulder.
During the amputation the surgeon will have a specific plan to accurately evaluate arterial flow in order to maintain the integrity of the skin flap once the surgery has been completed. Arterial vessels must be in the angle of the wound in order to maintain the integrity of the skin tissue.
The surgeon will also attempt to maintain as much musculature in the upper arm is possible in order to assist the individual in using an appliance after the wounds have healed.
There are 50,000 new amputations every year in the United States and the ratio of upper to lower limb is one to four. The most common is a partial hand amputation and the next common is the loss of one arm. 70% of all people with limb amputations are done distal to the elbow. This means that the amputation is done between the elbow and wrist. 60% of the amputations of the arm are done between the ages of 21 and 64 with only 10% under the age of 21 years of age. (1)
Most of these amputations are a result of occupational injuries and rarely are removed as a result of illness such as cancer. After amputation, individuals work with a rehabilitation team in order to be fitted with an appropriate prosthesis and go through a rehabilitation process to learn how to use the prosthetic appropriately.
Each prostheses will be different depending upon the specific needs of the individual. For instance, the prosthetic hand may resemble a hand from the outside but may not have too much function in the fingers if the individual does not require the use of that hand for occupational use or in order to take care of themselves if they are unable. On the other hand, individuals who continue to require occupational use of their hand or are fully capable of caring for themselves will use a prosthesis which is a bit different.
Components of the prosthetic may include fingers, hands, or wrist unit and an elbow unit. Movement of the hand is often controlled by the muscles in the stump and usually the shoulder muscles. A cloak may be more functional for most individuals but the majority of people prefer the way a prosthetic hand works.
Control of an above the elbow prosthetic is more complicated than that of a below the elbow prosthetic. Some of the newer technology includes microprocessors and myoelectrically powered joints. This enables a person to control movements with more precision but isn’t truly bionic.
A bionic prosthetics is one which moves without trigger from the individual who uses it based on the computer processor that anticipates the appropriate movement. For instance, the use of a bionic foot enables the individual greater stability because the toes of the foot will automatically grip the floor during walking motion which is not triggered by the individual wearing the prosthetic.
Rehabilitation for individuals to use an upper limb prosthetic includes general conditioning exercises as well as exercises to strengthen and stretch the shoulder and elbow. Endurance exercises may also be necessary in order to assist the individual to regain functional control of their upper body. The specific program prescribed will depend upon whether one or both arms were amputated and how much of the arm was taken.
Individuals who experience an upper limb amputation will learn how to do activities of daily living with the use of a prosthetic, adaptive devices or other parts of the body by going through an appropriate rehabilitation program. In order to accomplish these tasks most of individuals require strength, endurance, persistence and the desire to regain their previous level of function.
(1) National Limb Loss Information Center: Amputation Statistics by Cause