As i just checked past correspondence it turns out that I had written to the sales contact of Ossur Europe on December 14th 2009.
I had informed them their product Ossur Upper X (which I was equipped with) causes me both eczema at the stump end and, furthermore, constriction of my arm at the elbow - simply because they mass produce stump liners for cylindrical shape rather than my real stump shape which obviously is more conical.
In other words, their liners fit a stump that has the same circumference at any position (cylindrical shape) - whereas my stump is a bit more muscular, thick and wide at the elbow and thin and bony at the end (conical shape). That is the case because I am very active and keep fit, because I move a lot and do sports.
Now, Ossur advertises to be "the go-destination for athletes that want to be active" but that is not met by their products - the liners are geared towards amputees that, in fact, have cylindrical stumps. Legally, Ossur cannot be held responsible as they advertise to be a manufacturer for people that "want to be" active much rather than catering towards people that actually "are" active.
So given all that, I had asked them to produce the liner with a conical shape.
More specifically, I had written them the following text (in German, just for the record):
Mit dem Upper X Groesse 14, der vorne am Stumpf zu locker ist, habe ich nun vorne am Stumpf deswegen kleine Taschen, in denen der Schweiss sammelt und wo die Haut daher zu Ausschlag, Pilzinfekt und Ekzem neigt. Am Oberrand neben dem Liner ist dieser viel zu eng, dort habe ich vom starken Druck auch schon kleine Blasen gehabt.
Daher meine Bitte: - koennten Sie die Upper X Liner alternativ leicht konisch anbieten, vorne beim Pin sollte er etwas enger sein als hinten
In other words, I explained serious dermatological consequences of their liner design.
Rather obviously, I never got an answer.
To remedy the congestion problems, we moved to Upper X size 16. With that, my stump end is not compressed at all.
Over two years, I was mostly fine but now it appears that I did develop chronic congestion eczema - a brown induration of skin that scales and itches. It is similar to the congestion eczema that people with insufficient venous flow can get on their legs. The dermatologist said it was not hard to treat acute eczema symptoms such as outbreak, scales and the itch. But fixing the Ossur Upper X silicone liner situation given their deep frozen customer service attitude despite serious consequences warrants serious attention - solutions are extremely important and very expensive.
My stump circumference at the stump end is 14 cm, the liner measures 16 cm there. My stump circumference at the liner's entrance is 24 cm whereas the liner measures 18 cm there. Easy to see that the liner engorges, chokes, congests my stump.
I had unspecific eczema problems off and on, and a first serious bout of acute congestion eczema in August 2011. It went away fast after I had sought treatment. It now, end of December 2011, came back hard and it appears that now I cannot just use a bit of cream and all things are cool. Now we need to address underlying issues more thoroughly. The current trigger most likely is a minute change in my training specifics which seemed to have increased the stump's muscle mass around the elbow. Already existing problems were accentuated.
This photo shows the brown skin at the end of the stump after treating it with a steroid cream for a week. My dermatologist said to take it easy and so I did. It already is a lot better now. I stayed off the prosthetic arm for quite a bit and wore a compression sleeve.
My skin - close to the elbow - exhibits clearly recognizable compression marks. Figure below shows circumference values (cm).
The Ossur Upper X liner "sized 16 cm" actually is not a very good fit for my arm now. The last 3 months certainly saw an increase in my proximal stump diameter due to specific changes in sports and so understandably I would have to switch to a 14 cm / 24 cm liner - however it appears that Ossur neither listens to leave alone actually covers these concerns. There are no conical 14 / 24 cm liners in the Ossur stock items list or catalog.
Problems such as this are serious.
- the liner shape and design directly causes long term skin problems
- these skin problems have the potential to become serious
- the skin problems are uncomfortable and also increase pain that includes both stump pain and phantom pain
- they cause the amputee to suffer without affordable or available remedy
- Ossur is entirely aware of that but has consciously decided to run with the existing choice of liners
- and while ill fashioned Ossur Upper X liners cost around 800 CHF each (whoops), custom made silicone liners start around 3000 CHF a piece, which is prohibitively expensive
This is another situation where a prosthetic component manufacturer does appear, from my view point, to exert sadistic control over the situation of folks that depend on what technicians and insurances decide for them and that as a consequence run up nasty issues that are not at all a secret.
There is absolutely no concise reason why Ossur cannot produce conical liners covering a range of sizes just as I had requested in 2009.