Amputation Of Upper Arm And Shoulder
An amputation above the elbow should be designed to preserve as much length of the residual limb as possible. To function successfully, an artificial upper limb must have a long lever arm and as much of the humerus as possible should be saved to provide this lever (see images at top of page). Even a very short humerus stump should be retained if possible, because disarticulation of the shoulder greatly diminishes the powering of the artificial limb.
Occasionally, a kineplasty technique is used to enable the patient to operate the terminal device of an upper limb prosthesis. In this procedure, a tunnel is made beneath the biceps brachii muscle and the entire tunnel is covered with skin, creating a loop of muscle. The cables for the operation of a terminal device of an upper limb prosthesis are attached to this muscle loop.
This radical procedure is usually reserved for the treatment of aggressive, malignant tumors. In contrast to the disarticulation of the shoulder joint, a forequarter amputation removes all of the bone architecture and muscles of the upper limb (see images at bottom of page). It is a devastating amputation that provides no residual base to support an artificial limb. Consequently, it is usually very difficult to obtain a satisfactory fit of the prosthesis.