Summary of responses on Fore-Quarter amputation

Summary of responses on Fore-Quarter amputation

Thanks to all who replied.
Original post:
Dear List:
I have a friend - 34 year old Female who will have a Four-Quarter amputation
next week. She has a few questions regarding prosthetic options.
What type of prosthesis is used most functional or passive/cosmetic
only?
Do you have any patients amputated at this level who are successfully using
a functional prosthesis?
What are the special consideration when casting/fabricating/fitting a
Four-Quarter patient?
Also if you have a patient who would be willing to speak to this nice lady it
would be much appreciated.
Responses compiled will be posted with first name and credentials only.
Thanks,
Jack Richmond, Fillauer Inc.

Summary of responses on Forequarter amputation:
It's a forequarter amputation. Unfortunately the term come from the
slaughter term for the front shoulder of the beef verse the hind quarter of
the beef. :-{
Because of weight and complexity of the prosthesis most amputees don't wear a
full prosthesis for this level of amputation. Quite often they will use a
shoulder cap type to balance off their shoulders. Kim could give you some
suggestions for the passive design and who would be the closest good
prosthetist for this lady to visit.
Terry, CPO

Thanks for the correction Terry, uh, I knew that. I just wanted to see how
many would catch it. :-)

I have not worked with a Forequarter amputee for years but I have
done many cosmetic fillers in the past. I would make a hollow shell that
filled out clothing but did not attach a prosthesis to it so the patient
could retain a normal shape around the shoulder region. This would be worn
while the patient is still healing since it contacted the body on the outer
edges and not over the scar. It was very light and comfortable. Send a note
if you would like more specifics.
Bryan, CP

I worked in the past with a woman who had a forequarter amputation and was
employed as a customer service agent for an airline. She did the gate desk
job with computer, luggage, and everything. She had a very conventional
design for the socket which attached to her bra for suspension. She did
manage to operate a conventional Hosmer elbow and hook but I would consider
her to be exceptional. I have changed employers since then and lost contact
with her, so I can't give you her name. Your friend might consider powered
components with myo or servo control at this level to reduce the harness
force. Open frame sockets are much more comfortable and cooler. Good luck
to her.
Wayne, CPO

we have several 4 quarter amputees. All but one uses a shoulder cap
only. I did not fit the functional amputee but I do have a woman who has
a web site (toysrbob.com/onearm.html). She is really helpful in speaking
with people as well. Let me know if you do not find someone else for her
to speak with. I believe she could e-mail her via her web site as well.
I like to wait until they are healed completely. This are will have edema
and it will change in shape overtime. Good luck.
Stephanie, CPO, LP


i assisted on one last year and the patient did well with the surgery. get
lots of opinions on pain management. this was the worst thing afterward. also
she will need a cosmetic shoulder made before in order to hold her bra strap.
mike

 As you know, this level of amputation represents one that is very
complicated for prosthetic fitting and will require both expertise in the
fitting process as well as the decision making process for the appropriate
prosthetic option. Whether a person utilizes a functional or passive
prosthesis, it is very important to ensure that they have the appropriate
type of interface or socket fit. Therefore, I highly recommend that your
friend be seen by an individual who specializes in upper extremity
prosthetics. Additionally, a pre-surgical discussion between an experienced
upper extremity prosthetic specialist and the surgeon can be helpful to
insure optimal muscle and soft tissue preparation to facilitate prosthetic
function and comfort.

Specifically, a person may utilize a functional prosthesis which is usually
electric secondary to the inability to generate sufficient excursion for body
powered type of prosthetics. Individuals at this level often have a secondary
passive type of prosthesis made to be very light weight and worn in
situations in which the electric prosthesis is not necessary. It is
important to realize that the prosthesis is a tool and at the current state
of upper extremity technology, you need more than one tool to accommodate all
activities of daily living. Therefore, a functional and a passive prosthesis
may be appropriate. I would suggest a comprehensive evaluation be performed
with the patient in order to provide information regarding the six prosthetic
options available to her. During this evaluation, measurements of the
residual limb, remnant muscles and contralateral limb will be taken to
formulate the basis of plan. Further evaluations by occupational therapy will
provide direction for the rehabilitation plan.

At our Center of Excellence in Dallas, Texas we have an individual who is
scheduled to be fit in January with a myoelectric prosthesis who presents
with the four quarter or interscapulothoracic level of amputation. Your
friend could talk to this patient as she has been through passive prosthetic
fitting and desires a more functional prosthesis. Should your friend desire
to talk with this patient I will relay the appropriate contact information
(not to be forwarded to the list for privacy concerns) to you.
John M., CP, FAAOP