Tuesday, May 21, 2024

Advice needed – Orthotic options to play piano post humeral reconstruction

Lina Ng

Dear colleagues,

I’m writing for some advice regarding one of my patients, with a
rehabilitation goal of returning to playing the piano.

She is a 15 year old girl with a history of osteosarcoma in the left
proximal humerus. She underwent a surgical resection of the primary tumor,
and the humerus was reconstructed with fibular graft. She currently has no
pain in her shoulder, but has residual weakness on shoulder movements,
particularly abduction and flexion. There is no indication that she will
regain strength in abduction and flexion.

On examination of her left shoulder, she has the following ROM:
– Limited abduction to 80 degrees that improves on passive movement (100
degrees)
– Flexion limited to 80 degrees
– Extension 30 degrees
– External rotation limited to 100 degrees
– Internal rotation full ROM
– Full ROM in the elbow, wrist and hand

I’m currently looking into orthotic options for her to play the piano
without using her upper body extensively to reach keys further away from
midline. Does anyone have similar experiences or any advice? I’ve
shortlisted Medifab’s Dynamic Arm, but would appreciate more options of
varying costs.

Thank you in advance.

Regards,
Lina Ng
Prosthetist/Orthotist – Darwin, Australia

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