Abstract
Setting: Outpatient rehabilitation center. Patient: A 32-year-old woman after left traumatic above-knee amputation. This patient had been a pedestrian who was struck by a car and was thrown through a store window. Case Description: The patient presented 10 weeks after amputation with a complaint of inability to use her prosthesis because of severe groin pain. She reported that her prior therapist had the prosthetist adjust the prosthesis multiple times, but the groin pain did not abate. Her pain did not appear to relate to a prosthetic fitting issue. The patient’s pelvis was assessed and her left posterior superior iliac spine was 11/2in higher than the right side. Her left anterior superior iliac spine was lower and outflared excessively. She had a positive standing forward flexion test. Her left quadratus lumborum had markedly increased tissue density and was shortened. Assessment/Results: These findings were consistent with left anterior ilial rotation, out-flare, and up-slip. Intervention: To test the whether the pain was due to the pelvic dysfunction and not the prosthetic fitting, prosthetic modifications were held and the pelvis was treated with manual medicine techniques. Treatment included inferior mobilization with traction, muscle energy, strain and counterstrain, and posterior mobilization. Results: The patient’s anterior groin pain resolved after manual medicine treatment. No further prosthetic modifications were needed. Discussion: To our knowledge, this is the first published case of treatment of sacroiliac dysfunction after posttraumatic amputation. For this patient, proper prosthetic fitting was impaired because of pelvic dysfunction. We also noted some minor pelvic issues in other patients after traumatic amputations. Conclusion: A pelvic assessment should be done in all patients who have had traumatic amputations to optimize prosthetic fit and function.
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