Amputation Recommendations for Brachial Plexus Injury
Description
Collection
Title:
Amputation Recommendations for Brachial Plexus Injury
Date:
2/7/2011
Text:
Good Morning Colleagues,
I am consulting with a surgeon on a case that involves a flail arm secondary to brachial plexus injury. This patient presents with unbearable shoulder pain from the usual dislocating forces and there has been no return in distal function over the last two years. Unfortunately, this patient's sound side is not so sound secondary to the resulting trauma. The patient has decided to have his arm amputated with the hope that a prosthesis will provide an improved functional result.
The surgeon and I are debating where to amputate and what orientation to place the humerus in relative to the scapula. Since the musculature acting on the scapula is relatively intact, a transhumeral amputation is the primary direction of the surgeon. In this case, I have referenced back to the Atlas and Atkins texts that indicate fusing the humerus to the scapula in a flexed and abducted position. The Atkins text recommends 30 - 40 degrees of abduction and 30 to 45 degrees of forward flexion. The Atlas recommends 20 degrees of abduction, 30 degrees of forward flexion and 40 degrees of internal rotation. The Atlas recommendation is based on a reference from the 1970's. The surgeon has always been taught to fuse at 30 degrees of abduction, forward flexion, and internal rotation.
The variability of these recommendations bring me to the following questions. What have other prosthetists recommended? What was the functional outcome of those recommendations? Is there a more recent or extensive reference out there to review?
Thank you in advance for your assistance.
Sincerely,
Chris
____________________________________________
Chris Lake, L/CPO, FAAOP
Chief Clinical Director
Lake Prosthetics and Research
office: 682.214.1685
fax: 682.224.8430
mobile: 214.632.7980
www.lakeprosthetics.com< <URL Redacted>>
<Email Address Redacted> <mailto:<Email Address Redacted>>
By opening, printing, and/or viewing any correspondence and/or any digital files from Lake Prosthetics and Research, the reader acknowledges that the information furnished is, in all respects, confidential; therefore, reader agrees not to disclose, copy, distribute, and/or use it without the express written permission of Lake Prosthetics and Research. The content of all correspondence from Lake Prosthetics and Research is the property of Lake Prosthetics and Research. Upon request, any documents, digital or otherwise, are to be immediately returned to Lake Prosthetics and Research as well as destroyed and deleted from any digital storage medium. If you have received this communication in error, please immediately shred or delete it and all copies, and promptly notify the sender. Nothing in this communication is intended to operate as an electronic signature under applicable law.
I am consulting with a surgeon on a case that involves a flail arm secondary to brachial plexus injury. This patient presents with unbearable shoulder pain from the usual dislocating forces and there has been no return in distal function over the last two years. Unfortunately, this patient's sound side is not so sound secondary to the resulting trauma. The patient has decided to have his arm amputated with the hope that a prosthesis will provide an improved functional result.
The surgeon and I are debating where to amputate and what orientation to place the humerus in relative to the scapula. Since the musculature acting on the scapula is relatively intact, a transhumeral amputation is the primary direction of the surgeon. In this case, I have referenced back to the Atlas and Atkins texts that indicate fusing the humerus to the scapula in a flexed and abducted position. The Atkins text recommends 30 - 40 degrees of abduction and 30 to 45 degrees of forward flexion. The Atlas recommends 20 degrees of abduction, 30 degrees of forward flexion and 40 degrees of internal rotation. The Atlas recommendation is based on a reference from the 1970's. The surgeon has always been taught to fuse at 30 degrees of abduction, forward flexion, and internal rotation.
The variability of these recommendations bring me to the following questions. What have other prosthetists recommended? What was the functional outcome of those recommendations? Is there a more recent or extensive reference out there to review?
Thank you in advance for your assistance.
Sincerely,
Chris
____________________________________________
Chris Lake, L/CPO, FAAOP
Chief Clinical Director
Lake Prosthetics and Research
office: 682.214.1685
fax: 682.224.8430
mobile: 214.632.7980
www.lakeprosthetics.com< <URL Redacted>>
<Email Address Redacted> <mailto:<Email Address Redacted>>
By opening, printing, and/or viewing any correspondence and/or any digital files from Lake Prosthetics and Research, the reader acknowledges that the information furnished is, in all respects, confidential; therefore, reader agrees not to disclose, copy, distribute, and/or use it without the express written permission of Lake Prosthetics and Research. The content of all correspondence from Lake Prosthetics and Research is the property of Lake Prosthetics and Research. Upon request, any documents, digital or otherwise, are to be immediately returned to Lake Prosthetics and Research as well as destroyed and deleted from any digital storage medium. If you have received this communication in error, please immediately shred or delete it and all copies, and promptly notify the sender. Nothing in this communication is intended to operate as an electronic signature under applicable law.
Citation
“Amputation Recommendations for Brachial Plexus Injury,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/232263.
