Artificial limbs and their relation to amputations.

  • Great Britain. Ministry of Pensions
Date:
[1939]
Catalogue details

Licence: Public Domain Mark

Credit: Artificial limbs and their relation to amputations. Source: Wellcome Collection.

    97/118 page 73
    amputee. As a matter of fact, quite a number of men have been fitted with a through-shoulder type of prosthesis, and are making splendid use of it at many forms of manual labour. Its utility, however, depends very largely on the will of the wearer. In those cases where it is used the earning capacity of the amputee is definitely enhanced. If a prosthesis for manual labour is not desired, an alternative for dress purposes, which is considerably lighter, is available, and amputees should be encouraged to make use of it for it\restores the rounded appearance of the shoulder and protects the scar and prominent bones of the shoulder girdle. [The prosthesis for this and other amputations will be more fully described in later pages on the general classification of artificial arms and appliances.] All that need be said for the moment is that the principal part of the prosthesis for disarticulation at the shoulder is the shoulder cap. This may be either of leather, metal or certalmid. The cap is blocked on a cast and fitted accurately to the upper portion of the shoulder, including the clavicle anteriorly, and the spine of the scapula posteriorly. It is secured to the trunk by means of appendages. To this shoulder cap is attached, by means of a swivel or hinge joint, the upper arm socket, the forearm and the hand. The functional value of the prosthesis is increased if the scar is positioned vertically in the sub-acromion cavity, well out of the way of pressure by the shoulder cap. The axillary nerves should be free from pain, and the chest wall healthy and sound. (The upper end, or head, of the humerus should, if possible, be preserved intact, as it affords an ideal anchorage for the fitting of the prosthesis, and makes it easier to preserve the symmetry of the shoulders.) Where circumstances arise making it impossible for a through-shoulder arm to be worn, a protective shoulder cap should be prescribed. This is similar in construction to the cap already referred to. If made in certalmid it is exceedingly light in weight but affords the greatest protection to the shoulder. (3) The short upper-arm stump.—Where the level of bone section is 5”, or less, from the tip of the acromion process no stump is available for the control or working of a prosthesis and the prosthesis designed for dis- articulation at the shoulder is fitted. From the limb-fitting point of view, measurements of the stump in above-elbow amputations should be taken from the anterior fold of the axilla. If, therefore, the ordinary above- elbow artificial arm is to be worn, the minimum length of stump, measured from the inner fold of the axilla, must be between 1” and 2”, or between 5” and 6”, measured from the tip of the acromion process. By surgical interference it is sometimes possible to increase the length of these very short upper arm stumps by dividing and turning up the lower parts of the ' insertions of the pectoralis major, latissimus dorsi and teres major. It is thus possible to utilise the axilla and secure an increased measure of leverage and control over the prosthesis. Providing the length is sufficient to control the prosthesis, the short upper-arm stump can be fitted with the type of artificial arm available for the above-elbow stump of ideal length. The socket, however, will have to be carried up a little higher so that the upper part embraces the top of the shoulder; this is equivalent to what is termed a modzfied shoulder cap. (4) The long upper-arm stump.—While this may be a good stump from the surgical point of view, possessing all the necessary surgical features of the ideal stump, if the level of bone section is too low, say less than wM 20139 r
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