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Asymmetry due to below elbow amputation and consequences [analysis]

Cite this article:
Wolf Schweitzer: Technical Below Elbow Amputee Issues - Asymmetry due to below elbow amputation and consequences [analysis]; published December 10, 2014, 20:10; URL: https://www.swisswuff.ch/tech/?p=3789.

BibTeX: @MISC{schweitzer_wolf_1571443644, author = {Wolf Schweitzer}, title = {{Technical Below Elbow Amputee Issues - Asymmetry due to below elbow amputation and consequences [analysis]}}, month = {December},year = {2014}, url = {https://www.swisswuff.ch/tech/?p=3789}}


Asymmetry causes long term problems. Not wearing a prosthetic (at least over a longer time) is not an option. Overuse [link] and back problems are a serious issue. While overuse of the other / remaining / "intact" arm and hand is one aspect, asymmetry is the other aspect.

Both aspects require prosthetic arms to be comfortable to wear, and to be - grip wise, push wise, hold item wise - functional in an everyday sense. Any other type of prosthetic arm will be discarded or not worn in the long run, and thus not offer sufficient function to take load off the other overused extremity.

Both asymmetry and overuse as serious long term problems are usually neglected in current prosthetic arm design.

To keep the center of gravity centered - and above the pelvis or feet - the body shifts the weight in unilateral arm amputation with the effect, that the thorax is twisted, and the shoulder of the amputated side is elevated and brought forward [1].

Below elbow amputees  [2] get back pain (cervical spine: 8%; thoracic spine: 4%; lumbar spine: 33%), associated with scoliosis as found clinically (cervical spine: 67%; lumbar spine: 17%) and radiologically (cervical spine: 42%; lumbar spine: 17%). The cervical spine contained flattened discs (21%), osteochondrosis (21%) and spondylarthrosis (17%).The thoracic spine contained spondylosis deformans (50%) and spondylarthrosis (4%). Increased back muscle tonus is present on the side of the amputated arm in 92%, the shoulder was higher (71%) or lower (8%) on the amputated side, it was also pushed forward (70%) and back motion limitations were present in 33%. The stump itself contained osteophytes as osseous change (46%). Common complaints were fatigue pain both in the intact arm and the stump. Arthrosis of the wrist was present in 4% of upper limb amputees in the "intact" wrist. Arterial circulation is typically considerably weaker in the stump compared to the intact arm. In total, below elbow amputees suffer from localized back pains in 55% [1].

Persons wearing a prosthetic arm that is sufficiently heavy (but not too much distally [see problem with center of gravity]) and persons with active measures towards extending both arms for manipulations, keeping a consciously good posture, have a better chance of reducing the asymmetry, and its consequences [1].

Some problems are caused by a prosthetic arm, others are resolved by it. The art consists in finding the sweet spot between those problem zones.

asymmetrydiagram

 

With that, we are back to quantifying issues related to wearing prosthetic arms and possible consequences (see diagram). The axes all signify "10 best" and "0 worst" in terms of well being and performance; so the smaller the area contained in the curve the worse the choice and, for the developers, the bigger the potential areas of improvement - both in terms of asymmetry and chronic overuse.

  • Without prosthetic arm, posture and balanced movement is key. That can only be achieved with mindfulness and loads of exercise.
  • A hook prosthesis is so ugly one may be tempted to not wear it and that is the main problem really. Once you get that out of your system realizing that looks do not matter that much, it can be worn daily. Looks rather curious, but so do optical frames and bicycles.
  • The body powered hand is a good option overall, but its function and robustness is still second rate. One would want a hand looking device that has superb grip function though.
  • A "bionic" arm has not a real lot going for it, rationally, but it may be regarded as looking great and being a great gadget after all. And one can feel great wearing it, not around the back or shoulders but mentally.

References:

[1] B. Greitemann, V. Güth, and R. Baumgartner, "Asymmetrie der Haltung und der Rumpfmuskulatur nach einseitiger Armamputation-eine klinische, elektromyographische, haltungsanalytische und rasterphotogrammetrische Untersuchung," Zeitschrift für Orthopädie und ihre Grenzgebiete, vol. 134, iss. 06, pp. 498-510, 1996.
[Bibtex]
@article{greitemann1996asymmetrie,
  title={Asymmetrie der Haltung und der Rumpfmuskulatur nach einseitiger Armamputation-eine klinische, elektromyographische, haltungsanalytische und rasterphotogrammetrische Untersuchung},
  author={Greitemann, B and G{\"u}th, V and Baumgartner, R},
  journal={Zeitschrift f{\"u}r Orthop{\"a}die und ihre Grenzgebiete},
  volume={134},
  number={06},
  pages={498--510},
  year={1996},
  publisher={{\copyright} 1996 F. Enke Verlag Stuttgart}
}
[2] K. A. SOLONEN, H. RINNE, M. VIIKERI, and E. KARVINEN, "Late Sequelae of Amputation - Part II," Orthopedic and Prosthetic Appliance Journal, p. 64, 1966.
[Bibtex]
@article{solonenlate2,
  title={Late Sequelae of Amputation - Part II},
 year={1966},
journal={Orthopedic and Prosthetic Appliance Journal},
pages={64},
  author={SOLONEN, KAUKO A and RINNE, HJ and VIIKERI, M and KARVINEN,E}
}
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