Psychological problems after amputation
Amputations in the arm region cause greater functional and psychological disorders than those in the lower extremity. It is also more difficult to provide an optimal prosthetic fitting, since the demands on mobility cannot be met by the prosthesis in the same way as those on stability. The more extensive the loss of a limb, the more often arm amputees do not accept the prosthetic fitting.
In the case of unilateral amputation at shoulder level (shoulder disarticulation), the prosthesis is usually rejected. The main task of upper extremity prostheses is to take over the gripping function, but without the feedback via sensation (sensitivity) which is important for this. A certain sensory feedback, i.e. the perception of stimuli, can be achieved with conventional prostheses through the force-transmitting parts.
With active gripper arms, the force can be transferred from a bandage to the hand part via a cable pull. Of course, this possibility does not exist with electrically driven power prostheses, they are characterized by more favorable cosmetics than good function. If only the cosmetic needs are to be satisfied, jewelry hands or jewelry arms are also available.
An indispensable, albeit functionally poor, prosthetic fitting for bilateral shoulder disarticulation, as it can occur after an explosion injury, is essential to achieve a sufficient functional result. The problem of the rotationally stable (rotationally stable) prosthesis is particularly acute in the case of upper arm amputations, since the prosthesis shaft can often only be stabilized with difficulty on the cylindrical upper arm cross section. In some cases, surgical measures are necessary, such as bending the outer (distal) stump end in the case of long upper arm stumps, to facilitate fixation. Active gripper arms are preferred in this case:
Forearm prosthesis
In contrast, a myoelectric prosthesis is particularly suitable for a forearm amputation, especially if the ability to rotate the forearm is maintained. These are power prostheses in which each contraction of the muscles on the skin generates an electrical voltage which is used to control this electrical prosthesis. The Krukenberg technique is considered an alternative to the treatment of long forearm stumps, in which the ulna and radius are separated from each other with a soft tissue mantle in a scissor-like manner, thus maintaining a gripping function while maintaining sensitivity between the two bones. Prosthetic restorations are not possible in the hand region. The most likely options here are surgical, restorative (reconstructive) measures to build up the hand as an aid or to improve the gripping function by means of toe transplantation.
