No two situations of arm amputation are the same and the need for an amputation of the arm or hand is specific to each individual. However, no amputee is alone in their situation. Millions of people worldwide live with the loss of a limb or an extremity. 

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Shoulder disarticulation

A distinction is made here between shoulder girdle amputation and shoulder disarticulation. In a shoulder girdle amputation, not only the entire arm but also parts of the shoulder girdle are amputated. If the shoulder girdle is preserved and the shoulder joint is amputated, it is called shoulder disarticulation.

With such high amputations, far-reaching functional restrictions are to be expected. The higher the amputation, the more complex the situation and the more complex the subsequent fitting with a prosthesis will be.

Upper arm amputation

In the case of an amputation in the upper arm area, also called transhumeral amputation, the humerus is severed. A distinction is made between short, medium and long upper arm amputation heights. The different amputation heights have advantages and disadvantages in terms of functionality with and without a prosthesis.

Elbow disarticulation

Elbow disarticulation is an amputation in the elbow joint. The upper arm is usually completely preserved. Since the mobility of the elbow is lost, prosthetic components are used to compensate for this loss as much as possible. However, this is not entirely possible. Such a treatment can lead to an excess length in the upper arm compared to the preserved side.

Forearm amputation

Amputations in the area of ​​the forearm (transradial amputations) are divided into long, medium-length, short and ultra-short forearm amputations. Here, too, there are advantages and disadvantages in terms of functionality with and without a prosthesis. If the elbow joint is preserved, the outward and inward rotation of the forearm (pronation and supination) is retained.

Wrist disarticulation

In the case of wrist disarticulation, the entire hand in the area of ​​the wrist is removed. This means that the ability to move the wrist is lost. In the case of a prosthetic restoration, it can also be excessively long compared to the preserved side. This must be observed in order to avoid functional restrictions (e.g. bringing the fork to your mouth).

Hand / finger amputation

Partial hand amputations are all amputations distal (away from the heart) of the wrist. Parts of the hand and / or fingers are amputated. Compared to wrist disarticulation, the wrist is preserved and therefore, as a rule, its function as well. In combination with a prosthesis, a gripping function is made possible for remaining fingers or partial fingers.

% occurrence of upper limb absence

Upper limb absence can be categorised from partial hand absence to complete absence of the arm. The precise level of absence is defined based on the anatomy, using the description ‘trans’ if it is through the bone and ‘disarticulation’ if it is through the jont. Absence of the finger or partial finger is categorised as ‘minor’ absence. It is estimated that there are five times more minor upper limb amputations than major ones, however they are often not reported in prosthetic figures as the individual retains a good level of function within their hand and is not referred for prosthetic assessment. This chart shows the occurrences of major upper limb absences.

Arm and hand amputations are primarily due to trauma, accounting for over 75% with dyvascular causes accounting for a further 20%.There are approximately 25,000 new amputations globally each year and while the rates vary from location to location, within each part of the world the rates of amputation remain steady.

Upper limb amputees tend to be younger than lower limb amputees overall, 66% of new referrals are younger than 55 years old. This correlates with the majority being congenital or trauma rather than vascular conditions.

Arm amputation should be considered a reconstructive procedure to restore the anatomy or the function of the body part to normal. In most cases, amputation surgery is performed to remove a section of the limb rather than the entire limb. The surgeon’s goals are to reduce pain and discomfort and leave the patient with the optimal residual limb for use with an appropriate prosthetic device. Despite great strides being made in the technology available, the complex movements, dexterity, sensitivity and functionality of the human extremities cannot currently be fully reproduced by using a prosthesis.

The goal of the multidisciplinary team (MDT), regardless of the underlying diagnosis, is that they will work together to provide the optimal outcome for each patients individual needs and goals. Discussing all expectations along the rehab journey, they will all work together to provide the optimal outcome for the patient, their wants and needs.

Your team in the hospital

Users benefit from a multidisciplinary team consisting of surgeons, prosthetists and therapists who have experience in the area of ​​the affected extremity. Having a team that inspires trust and confidence is the best starting point for a quick way back to a mobile, active life and a high quality of life

Medical team – doctors and nurses

Unless the amputation is as a result of an accident or an emergency  operation, it is the medial team’s responsibility to ensure that the patient is informed about the planned procedure and the next steps. Don't be afraid to ask all the questions that are important and keep asking until everything is clarified. A list of questions prepared in advance can be helpful. The nursing staff are important contacts during a hospital stay in order to clarify questions about wound care, residual limb care and any other questions that may arise.

Physiotherapists

If possible, sessions with a physiotherapist should be attended ahead of an amputation.

Targeted exercises help to prepare for the situations that await after the amputation, such as transferring from bed to wheelchair or balance exercises.

Occupational therapists

Solutions for rehabilitation and prosthesis will be introduced to the patient and family members early on in the process. It is important to start this intervention at an early stage in order to reduce uncertainties and fears, manage expectations, offer support and to ensure that the patient and their family are involved in the rehabilitation care. Muscles that will later be used to control the prosthesis can already be trained at this stage. The team will also discuss individual functional needs, goals and wishes that would like to be achieved with a prosthesis in the future.

Prosthetists

A prosthetist should be involved in the process at an early stage. Together with the patient, doctors and physiotherapists / occupational therapists, they will discuss which prosthesis or prosthetic components are medically sensible and meet their needs. The prosthetist is an important companion on the way back to mobility and independence, as they are responsible for all aspects of prosthetic care. It is all the more important that a good relationship of trust is built with them.

 Psychologists

Many people experiencing amputation can be left feeling alone or isolated even though this may not be the case. It is important to seek help; if those feelings begin to manifest, speak to a psychologist. Talking to a mental health professional can help to alleviate worries and fears and can work towards preventing or treating any symptoms of depression. Seeking help with mental health is not a weakness and is not something to be ashamed of, in fact the support received can not only benefit the patient but also the friends and family surrounding them, helping everybody involved quickly gain new strength.

In addition, it helps many people to discuss upcoming changes, worries and fears with other amputees. People who have experienced a similar situation can relate to the concerns that are being raised and can often give good tips and advice.