Amputation Recommendations for Brachial Plexus Injury
Good Morning Colleagues,
I am consulting with a surgeon on a case that involves a flail arm secondary to brachial plexus injury. This patient presents with unbearable shoulder pain from the usual dislocating forces and there has been no return in distal function over the last two years. Unfortunately, this patient's sound side is not "so sound" secondary to the resulting trauma. The patient has decided to have his arm amputated with the hope that a prosthesis will provide an improved functional result.
The surgeon and I are debating where to amputate and what orientation to place the humerus in relative to the scapula. Since the musculature acting on the scapula is relatively intact, a transhumeral amputation is the primary direction of the surgeon. In this case, I have referenced back to the Atlas and Atkins texts that indicate fusing the humerus to the scapula in a flexed and abducted position. The Atkins text recommends 30 - 40 degrees of abduction and 30 to 45 degrees of forward flexion. The Atlas recommends 20 degrees of abduction, 30 degrees of forward flexion and 40 degrees of internal rotation. The Atlas recommendation is based on a reference from the 1970's. The surgeon has always been taught to fuse at 30 degrees of abduction, forward flexion, and internal rotation.
The variability of these recommendations bring me to the following questions. What have other prosthetists recommended? What was the functional outcome of those recommendations? Is there a more recent or extensive reference out there to review?
Thank you in advance for your assistance.
Chris Lake, L/CPO, FAAOP
Chief Clinical Director
Lake Prosthetics and Research
[Email Address Removed]
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