Transhumeral Amputations and Elbow Disarticulations

Elbow dislocations and Transhumeral amputations are classified as catastrophic injuries and most always require the involvement of an experienced catastrophic injury lawyer.

In an elbow disarticulation, the entire radius and ulna are separated from the body at the level of the elbow, whereas, in a transhumeral amputation, the stump is above the level of the elbow.  Most of these types of amputations involve severe trauma to the arm and occur four times as often in men, usually those who get injured in the workplace or in an accident.
 
Because medicine has become so advanced, anytime a limb has been severed above the elbow or damaged in the forearm, replantation of the arm is recommended.  This is because a replanted arm functions better than any prosthesis ever could.
 
When the arm needs to be severed due to injury or illness, doctors should try to keep as much of the humerus intact as possible.  The longer the stump is, the easier it is to have a functional prosthesis.  Cutting the arm off at the level of the elbow by disarticulating the bones attached to the elbow gives the longest stump; however, it doesn’t make room for being able to bend at the elbow, whereas a shorter stump involving the humerus can have a prosthesis that has an artificial bendable elbow.
 
If possible skin and muscle flaps are used to comfortably cover the end of the humerus or the midshaft of the humerus, depending on the level of amputation.  Having a protected bony end can make it easier to attach a prosthesis comfortably.  Because the end of the humerus has wide epicondyles (prominences) at the end of the bone, these prominences are often trimmed away so they don’t rub on the prosthetic device.  Otherwise, they will stick out and create a bulbous stump that doesn’t fit well with available prostheses.
 
Prostheses for Upper Arm or Elbow Disarticulation Amputations
 
A good upper arm prosthesis involves these key elements:
  • Enough of a stump to create a lever, which will be the artificial elbow
  • Healthy skin to attach the prosthetic device to
  • Good muscle function of the upper arm
  • Good pain control of the stump
  • Good range of motion of the shoulder
  • A good rehabilitation team to help the amputee regain function of the arm
Even under the best of circumstances, less than half of all individuals who lose their upper arm at the level of the elbow or above actually stick with using a prosthesis.  Those who elect to use just their remaining arm risk overuse of the opposite arm.  In fact, this happens in about 50 percent of cases, making a case for trying to use a prosthesis of the injured arm.
 
For those who elect to use a prosthesis, they have better luck if a long humerus is remaining.  This makes for a lighter weight prostheses that functions better than those attached to a shorter humerus.  The trick is to have muscle padding the end of the humerus but not to have so much redundant tissue so that a prosthesis is too clumsy to attach.  If the residual stump is too short, doctors can try to elongate the humerus through the use of a bone graft, such as from undamaged parts of the radius that has been removed.
 
When the stump involves a part of the humerus, the socket must be snuggly fitting so it doesn’t gap when the person moves the shoulder around.  This can be especially hard to accomplish when the stump of the arm above the elbow is very short.  Suction is used to suspend the socket so that minimal harnessing is necessary.

When the prosthesis is attached following an elbow disarticulation, the protuberances (epicondyles) at the end of the humerus can act as suspenders for a prosthesis.  The epicondyles are inserted into the prosthesis and locked into place so that the epicondyles serve to hold the prosthesis on.  Some prostheses can be made that effectively “screw” the epicondyles in place when putting on the prosthetic device.
 
As in lower limb prostheses, it is best to use a prosthesis as soon as possible so the patient can psychologically feel better about having a prosthesis and can practice with a prosthesis soon after the stump has begun to heal.
 
Many people with an upper arm prosthesis make use of two types of prostheses.  One has a claw on the end for faster grasping and greater control, and the other is a more esthetically-pleasing prosthesis that isn’t as functional as the claw types of prostheses.  Sometimes the prostheses can be body-controlled while others require myoelectric control in order to function as normally as possible for the amputee.
 
The prosthesis the person has shortly after their amputation is different from the prostheses they will have later on.  This is because prostheses are usually specific to a certain activity, such as grasping or cycling, necessitating special prosthetic devices f for the various prosthetic needs.
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