UNIQUE UPPER LIMB CASE PRESENTATIONS
John W. Michael, MEd, CPO/L, FISPO, FAAOP

This lecture uses digital photos and video to present a series of “virtual patients” who present with an unusual or complicated clinical picture that includes a unilateral upper limb deficiency.  The audience is able to “see” each patient’s residual limb and a summary of pertinent clinical findings.  The discussions that follow illustrate the specific biomechanical problems presented by each individual, along with their personal rehabilitation goals.

The presentation then illustrates the specific approach taken to successfully fit each patient, and presents the results of follow-up regarding the long-term outcome.  Alternative methods of treatment are also discussed, and the relative advantages and disadvantages reviewed.

Case illustrations include two transradial cases.  The first is a lady with an extremely short transradial congenital absence who hasn’t worn a prosthesis since she was a toddler.  The second is a welder with a transradial amputation secondary to severe burns that resulted in hypertrophic scarring on the torso and involved arm, as well as a very restricted range of elbow motion.  Two additional cases involve amputations proximal to the elbow joint: a cancer survivor who has rejected figure eight, figure nine, and European harnessing yet wishes to use a body powered elbow, and a young man with a Linberg-Tikoff resection.

Management of these challenging cases combines careful assessment of their residual physical capabilities, biomechanical deficiencies, and functional aspirations with innovative use of available components and materials, as well as one-of-a-kind harnessing variants.  The purpose of this case series is to illustrate the problem-solving approach that is often required to treat upper limb amputees.