Shoulder Disarticulation Research Articles

Embedded Machine Learning System for Muscle Patterns Detection in a Patient with Shoulder Disarticulation.

The integration of artificial intelligence (AI) models in the classification of electromyographic (EMG) signals represents a significant advancement in the design of control systems for prostheses. This study explores the development of a portable system that classifies the electrical activity of three shoulder muscles in real time for actuator control, marking a milestone in the autonomy of prosthetic devices. Utilizing low-power microcontrollers, the system ensures continuous EMG signal recording, enhancing user mobility. Focusing on a case study-a 42-year-old man with left shoulder disarticulation-EMG activity was recorded over two days using a specifically designed electronic board. Data processing was performed using the Edge Impulse platform, renowned for its effectiveness in implementing AI on edge devices. The first day was dedicated to a training session with 150 repetitions spread across 30 trials and three different movements. Based on these data, the second day tested the AI model's ability to classify EMG signals in new movement executions in real time. The results demonstrate the potential of portable AI-based systems for prosthetic control, offering accurate and swift EMG signal classification that enhances prosthetic user functionality and experience. This study not only underscores the feasibility of real-time EMG signal classification but also paves the way for future research on practical applications and improvements in the quality of life for prosthetic users.

Bilateral shoulder disarticulation after high-tension electrical burns: a case report

Background: High tension electrical burns are rare but devastating injuries with high mortality usually from overwhelming sepsis, poor cardiovascular support and multiple organ dysfunction syndrome (MODS). However, survivors of such burns have varying degrees of injuries with significant morbidity especially after radical amputation to save their lives. The objective of this case report was to present this rare scenario and highlight the importance of prompt intervention and acute surgical management that improves survival. Case report: This was a descriptive case report of a 23-year-old male, a survivor of high-tension electrical burns (11,000volts) to both upper limbs. He had immediate admission into the intensive care unit with ventilatory support and multi-disciplinary approach to care. He had some investigations which included daily full blood count, serum electrolytes, urea and creatinine, clotting studies, blood sugar, urine analysis, lactate level, iron and creatine kinase studies, chest x-rays, electrocardiogram and abdominopelvic scan. He had multiple blood products transfusion; antibiotic therapy, staged surgeries including bilateral shoulder disarticulation to control sepsis and preserve life. He was discharged home with healed disarticulated shoulders and satisfactory clinical condition after 35 days on admission. Conclusion: Early resuscitation, cardiovascular support in the intensive care unit, urgent wound debridement and amputation of devitalized limb were life-saving interventions. These prompt care improved his survival chances following high -tension electrical burns.

Interactive control algorithm for shoulder-amputated prosthesis and object based on reinforcement learning

As a prosthesis made to compensate for the residual loss of the amputee’s limb, the shoulder disarticulation upper limb prosthesis replaces the missing arm function of the shoulder amputee to a certain extent. However, the current upper limb prosthesis mainly interacts with the outside world through the prosthetic hand for grasping and gripping, and the interaction between other parts and the environment is often neglected, which is not in line with the use habits of the human arm. To address this problem, this paper proposes a reinforcement learning–based method for controlling the forearm interaction of a shoulder-disconnected upper limb prosthesis, and analyzes and solves the forces during the interaction, reducing the impact of uncertainty on interaction actions and accelerating training while ensuring the stability of handheld items. We evaluated the performance of the control method during the interaction between the upper limb prosthesis and the external environment through simulation experiments. After the training, the bionic arm was able to push the object into the target range for different objects and pushing distance requirements, which showed the good control effect of the method. Also, the control method can be applied to improve the interaction between the robotic arm and the environment.

Combined interscalene brachial plexus block and superficial cervical plexus block for shoulder disarticulation surgery in a terminal cancer patient.

Combined interscalene brachial plexus block and superficial cervical plexus block for shoulder disarticulation surgery in a terminal cancer patient.

Bilateral shoulder disarticulation after high-tension electrical burns: a case report

Background: High-tension electrical burns are rare but devastating injuries with high mortality usually from overwhelming sepsis, poor cardiovascular support and multiple organ dysfunction syndrome. However, survivors of such burns have varying degrees of injuries with significant morbidity especially after radical amputation to save their lives. The objective of this case report was to present this rare scenario and highlight the importance of prompt intervention and acute surgical management that improves survival. Case Report: This was a descriptive case report of a 23-year-old male, a survivor of high-tension electrical burns (11,000 volts) to both upper limbs. He was immediately admitted into the intensive care unit with ventilatory support and multi-disciplinary approach to care. He had some investigations which included daily full blood count, serum electrolytes, urea and creatinine, clotting studies, blood sugar, urine analysis, lactate level, iron and creatine kinase studies, chest X-rays, electrocardiogram and abdominopelvic scan. He had multiple blood products transfusion; antibiotic therapy, staged surgeries including bilateral shoulder disarticulation to control sepsis and preserve life. He was discharged home with healed disarticulated shoulders and satisfactory clinical condition after 35 days on admission. Conclusion: Early resuscitation, cardiovascular support in the intensive care unit, urgent wound debridement and amputation of devitalized limb were life-saving interventions. These prompt care improved his survival chances following high -tension electrical burns.

Combined interscalene, superficial cervical plexus and thoracic intertransverse process blocks for surgical anaesthesia of the shoulder disarticulation.

Combined interscalene, superficial cervical plexus and thoracic intertransverse process blocks for surgical anaesthesia of the shoulder disarticulation.

Development of Customized Passive Arm Prosthetics by Integrating 3D Printing and Scanning Technology

Severe hand injuries resulting from accidents can lead to the traumatic loss of an upper limb. The provision of an assistive device, such as an arm prosthesis, can help patients regain their courage and motivation to engage with the public. This project aimed to integrate 3D scanning and printing technology to develop a customized passive arm prosthesis for individuals who have experienced shoulder disarticulation due to a traumatic accident. The fabrication of the arm prosthesis was specifically designed and tailored to meet each patient’s unique needs and preferences. The prosthesis design was created based on 3D scan files obtained from the patients. Finite element analysis was employed to analyze the design and determine the optimal materials to use, as well as to optimize the overall design. The finalized model was then converted into STL file format and G-code for the 3D printing process. To ensure ease of use, the entire arm prosthesis and a harness system were assembled, and multiple tests and fittings were conducted on the patient. Several prototypes of the arm prosthesis were fabricated to achieve the best fit for each individual patient.

Myoelectric prosthesis hand grasp control following targeted muscle reinnervation in individuals with transradial amputation.

Despite the growing availability of multifunctional prosthetic hands, users' control and overall functional abilities with these hands remain limited. The combination of pattern recognition control and targeted muscle reinnervation (TMR) surgery, an innovative technique where amputated nerves are transferred to reinnervate new muscle targets in the residual limb, has been used to improve prosthesis control of individuals with more proximal upper limb amputations (i.e., shoulder disarticulation and transhumeral amputation). The goal of this study was to determine if prosthesis hand grasp control improves following transradial TMR surgery. Eight participants were trained to use a multi-articulating hand prosthesis under myoelectric pattern recognition control. All participated in home usage trials pre- and post-TMR surgery. Upper limb outcome measures were collected following each home trial. Three outcome measures (Southampton Hand Assessment Procedure, Jebsen-Taylor Hand Function Test, and Box and Blocks Test) improved 9-12 months post-TMR surgery compared with pre-surgery measures. The Assessment of Capacity for Myoelectric Control and Activities Measure for Upper Limb Amputees outcome measures had no difference pre- and post-surgery. An offline electromyography analysis showed a decrease in grip classification error post-TMR surgery compared to pre-TMR surgery. Additionally, a majority of subjects noted qualitative improvements in their residual limb and phantom limb sensations post-TMR. The potential for TMR surgery to result in more repeatable muscle contractions, possibly due to the reduction in pain levels and/or changes to phantom limb sensations, may increase functional use of many of the clinically available dexterous prosthetic hands.

On optimal and varying decompositions for transradial contraction force prediction in upper-limb prosthesis

• Enhanced means of predicting phantom motion using a novel signal decomposition method. • A varying gain control system for an adaptive means towards dealing with force contraction variation. • Adaptive Pattern Recognition. The abilities to recognise an intended gesture alongside its associated contraction force are both useful features which could contribute towards the advancement of bionic upper-limb prosthesis. A substantial amount of related literature appears to address these problems separately instead of as part of a sequential control system. As part of an ongoing research on this topic, this work addresses the second portion of a multi-stage advanced prosthesis control system on the prediction of the contraction force used in producing a specific gesture motion. This problem was tackled using a novel decomposition method whose decomposition parameters could be varied based on a recognised gesture motion for an optimal decomposition of the sources signal, which is capable of maximising the prediction accuracy of the control system. The results showed a 10–20% increase in the classification accuracy using this method when compared with processing done with purely the raw acquired signal. Subsequent work would now involve the testing of this proposed control system on other categories of amputees such as transhumeral and shoulder disarticulation, in order to investigate its generalisation capability.

Damn Nuisance from brachial Plexus Injury, An Uncommon Indication for Shoulder Disarticulation

Pan-plexus injuries with persistent pain and flail upper limb present bifocal nuisance to patients and pose serious treatment challenges to orthopaedic surgeons. Limb salvage procedures could be cumbersome, expensive and mostly with poor functional outcomes. The timing and extent of ablation are key predictors to outcome and will depend on the available local expertise and clinical evidence. We present a 42year farmer who walked into the clinic requesting for limb ablation. We also discuss our treatment outcome in light of available literature.

Advances in upper limb loss rehabilitation: the role of targeted muscle reinnervation and regenerative peripheral nerve interfaces

Upper limb loss results in significant physical and psychological impairment and is a major financial burden for both patients and healthcare services. Current myoelectric prostheses rely on electromyographic (EMG) signals captured using surface electrodes placed directly over antagonistic muscles in the residual stump to drive a single degree of freedom in the prosthetic limb (e.g., hand open and close). In the absence of the appropriate muscle groups, patients rely on activation of biceps/triceps muscles alone (together with a mode switch) to control all degrees of freedom of the prosthesis. This is a non-physiological method of control since it is non-intuitive and contributes poorly to daily function. This leads to the high rate of prosthetic abandonment. Targeted muscle reinnervation (TMR) reroutes the ends of nerves in the amputation stump to nerves innervating “spare” muscles in the amputation stump or chest wall. These then become proxies for the missing muscles in the amputated limb. TMR has revolutionised prosthetic control, especially for high-level amputees (e.g., after shoulder disarticulation), resulting in more intuitive, fluid control of the prosthesis. TMR can also reduce the intensity of symptoms such as neuroma and phantom limb pain. Regenerative peripheral nerve interface (RPNI) is another technique for increasing the number of control signals without the limitations of finding suitable target muscles imposed by TMR. This involves wrapping a block of muscle around the free nerve ending, providing the regenerating axons with a target organ for reinnervation. These RPNIs act as signal amplifiers of the previously severed nerves and their EMG signals can be used to control prosthetic limbs. RPNI can also reduce neuroma and phantom limb pain. In this review article, we discuss the surgical technique of TMR and RPNI and present outcomes from our experience with TMR.

Clinical outcome in patients who underwent amputation due to extremity soft tissue sarcoma: Tokai Musculoskeletal Oncology Consortium study.

Soft tissue sarcomas are a diverse group of rare malignant tumours, mostly occurring in the lower extremities. Amputations are necessary for achieving local control when the soft tissue sarcomas are too large and/or have neurovascular involvement. Patients who require amputation have a poorer prognosis than those who undergo limb-salvage surgery. We investigated the tumour characteristics and the clinical outcomes in 55 patients with primary soft tissue sarcomas, who underwent amputation. We excluded patients with amputation performed distal to the wrist or ankle joints and those with recurrent soft tissue sarcomas. The mean tumour size was 11.1cm. Hip disarticulation was performed in 6 patients, 20 underwent above the knee amputation, 8 underwent knee disarticulation and 12 underwent below the knee amputation. Shoulder disarticulation was performed in three patients, five underwent above the elbow amputation, and one underwent below the elbow amputation. The 5-year disease-specific survival rate was 52.8%. The 5-year recurrence-free survival rate and 5-year metastasis-free survival rates were 90.1% and 38.5%, respectively. Larger tumour size, age and the distant metastases at first presentation were predictors of poor prognosis for survival in multivariate analysis. Twenty-eight patients could walk using artificial limbs. The level of amputation (above versus below the knee) showed a significant difference in achieving independent gait. Amputation is a useful treatment option for achieving local control in patients with large soft tissue sarcomas. Patients had an opportunity of walking, especially for those who underwent below the knee amputation.

Factors influencing perceived function in the upper limb prosthesis user population.

Patient-reported outcomes (PROs) can be used to evaluate perceived capacity of an individual in executing tasks in a natural environment with their prosthetic device. According to the World Health Organization International Classification of Health, Functioning, and Disability (ICF) models, there may be specific factors of a person, factors of assistive prosthetic technology, or factors related to the health condition or body function that affect their functioning and disability. However, an understanding of factors affecting an upper limb prosthesis user's perception of their ability to execute tasks in a natural environment is not well established. To use the ICF model to identify which health condition-related, body function, environmental, and personal factors influence activity as measured by perceived function in the upper limb prosthesis user population. Quantitative clinical descriptive study. Clinical offices within outpatient private practice (removed for blinding). A sample of 101 participants with upper limb amputation who use a prosthetic device and were undergoing a prosthesis fitting process. Not applicable. PROs on pain with/without a prosthesis, satisfaction, and perceived function derived from the Comprehensive Arm Prosthesis and Rehabilitation Outcomes Questionnaire. Model coefficients indicate that with a unit increase in satisfaction (p< .001) and pain (p= .031) scores (with higher pain scores signifying less pain), the mean of perceived function increases by 0.66 and 0.47 units, respectively. Conversely, for individuals with elbow disarticulation, transhumeral, shoulder disarticulation, and interscapulothoracic amputations, the mean of perceived function decreases by 22.02 units (p= .006). Based on our sample, perceived function is significantly associated with satisfaction, pain, and amputation level. These findings could potentially help to inform initial clinical approach and targeted outcomes for patients based on these factors.

Shoulder girdle recognition using electrophysiological and low frequency anatomical contraction signals for prosthesis control

Shoulder disarticulation amputees account for a small portion of upper-limb amputees, thus little emphasis has been devoted to developing functional prosthesis for this cohort of amputees. In this study, shoulder girdle recognition was investigated with acquired data from electrophysiological (electromyography [EMG]) and low frequency contraction (accelerometer [Acc]) signals from both amputee and non-amputee participants. The contribution of this study is based around the contrast of the classification accuracy (CA) for different sensor configurations using a unique set of signal features. It was seen that the fusion of the EMG-Acc produced an enhancement in the CA in the range of 10%–20%, depending on which windowing parameters were considered. From this, it was seen that the best combination of a windowing scheme and classifier would likely be for the 350 ms and spectral regression discriminant analysis, with a fusion of the EMG-Acc information. The results have thus provided evidence that the two sensors can be combined and used in practice for prosthesis control. Taking a holistic view on the study, the authors conclude by providing a framework on how the shoulder motion recognition could be combined with neuromuscular reprogramming to contribute towards easing the cognitive burden of amputees during the prosthesis control process.

Hydatid bone disease of the humerus: A case report from East Africa

Skeletal hydatidosis is extremely rare and involvement of the long bones of the appendicular skeleton is exceptional. We report on a case of a 68-year-old Ugandan woman who presented with a long standing history of a non-healing fracture of the mid-diaphysis of the right humerus. She had undergone multiple surgeries in peripheral health centres during the previous years. A shoulder disarticulation was carried out in our facility in agreement with the patient, who refused any other attempt of bone reconstruction. A diagnosis of hydatid bone disease was confirmed intra-operatively. There is no recurrence of the disease for a two-year follow-up period. To our knowledge this is the first case report of skeletal hydatosis in Uganda. It emphasises the diagnostic difficulties and delays, and how this led to inadequate management for the patient in this case.

Understanding the Relationship Between Patient-Reported Function and Actual Function in the Upper Limb Prosthesis User Population: A Preliminary Study

ObjectiveTo understand how perceived function relates to actual function at a specific stage in the rehabilitation process for the population using upper limb prostheses. DesignQuantitative clinical descriptive study. SettingClinical offices. ParticipantsA sample of 61 participants (N=61; mean age, 43.0±12.8y; 51 male/10 female) with upper limb amputation who use a prosthetic device and were in the definitive stage of a prosthesis fitting process. InterventionsNot applicable. Main Outcome MeasuresA patient-reported outcome measure, the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), and 2 performance-based outcome measures, Box and Blocks Test (BBT) and Capacity Assessment of Prosthesis Performance for the Upper Limb (CAPPFUL), were used as variables in multiple linear regression models. ResultsThe multiple linear regression models, which controlled for prosthesis type and amputation level, did not show evidence that changes in the independent variable (DASH) are significantly associated with changes in the dependent variables (log(BBT) (B=−0.007; 95% confidence interval [CI], −0.015 to 0.001; P=.0937) and CAPPFUL (B=−0.083, 95% CI, −0.374 to 0.208; P=.5623)). In both models, individuals with elbow, transhumeral (above elbow), and shoulder disarticulation showed a significant negative association with the dependent variable (CAPPFUL or logBBT). In the CAPPFUL model, there was a significant negative association with individuals using a hybrid prosthesis (B=−20.252; 95% CI, −36.562 to −3.942; P=.0170). In the logBBT model, there was a significant positive association with individuals using body-powered prostheses (B=0.430; 95% CI, 0.089-0.771; P=.0157). ConclusionsAlthough additional data and analyses are needed to more completely assess the association between self-reported measures and performance-based measures of functional abilities, these preliminary results indicate that patient-reported outcomes alone may not provide a complete assessment of an upper limb prosthesis users’ functional ability and should be accompanied by population-specific performance-based measures.

Anaesthetic Management of a Patient with Necrotizing Fasciitis: A Case Report

Necrotizing fasciitis is a highly lethal bacterial infection of subcutaneous tissue and fascia. 77 year old male patient, smoker with necrotizing fasciitis underwent surgery:- left shoulder disarticulation in emergency OT under general anesthesia. Intraoperatively, the patient went into severe sepsis and developed arrythmias and hypotension which was managed with anti-arrythmic drugs and infusion norepinephrine. The patient responded to the treatment and the surgery was completed. Postoperatively mechanical ventilation was continued and subsequently the patient improved and was extubated 3 days later. Keywords: Necrotizing fasciitis, necrotizing acute soft tissue injury, NASTI.

667 Necrotizing Soft Tissue Infection Within 48 Hours Post-Scald Burn: A Rare Presentation

Abstract Introduction We report a case of a patient with a burn injury who developed a devastating necrotizing soft tissue infection (NSTI) early in the post-burn period. Methods An elderly male was admitted to an ABA verified burn centre after sustaining a 20% scald burn to his back and right upper extremity. He was found in the bathtub; a fall was suspected based on his history of Parkinson’s disease and a finding of bruising to his bilateral knees. Initially, his hospital course was uneventful apart from an elevated creatine kinase, which decreased with adequate resuscitation without signs or symptoms of compartment syndrome. Thirty-six hours following his admission, he developed rapid onset of progressively worsening renal function, respiratory requiring intubation, mechanical ventilation, and circulatory failure requiring vasopressor support. After ruling out other causes of shock and upon re-examination of his burns there were clinical signs of a rapidly advancing necrotizing soft tissue infection. He was taken urgently to the operating room for aggressive debridement of nonviable tissue. He underwent a right shoulder disarticulation and extensive debridement of the right chest, abdomen, and back. Intra-operative tissue samples and preoperative blood cultures were positive for Group A Streptococcus. The patient was predicted to require multiple operations and a prolonged hospital stay. Despite these interventions, his prognosis was poor. The family and the treatment team, in the context of the patient’s previous independent functioning, revised his goals of care on his first post-operative day. Life-sustaining treatment was withdrawn, and comfort care measures were implemented. The patient passed away two days later. Results We report a case of a patient with a burn injury who developed a devastating NSTI early in the post-burn period within 36–48 hours of presentation to a burn center. Soft-tissue infections in the immediate post-burn period are rare unless there is subsequent contamination. Burned tissue contains a large amount of necrotic tissue and protein-rich wound exudate, which provides a rich growth medium for bacteria. This, in addition to the immunosuppression secondary to the burn insult, favors the development of infection. NSTI in the context of thermal injury is a rare phenomenon and in the few reported cases in burn patients, necrotizing infections occurred closer to two weeks following the initial injury. Conclusions Necrotizing soft tissue infections are entities with a rapid and devastating course. The diagnosis is challenging, and occlusive dressings may contribute to a delay in diagnosis in burns. Acute hemodynamic compromise without any obvious cause should raise the suspicion for a necrotizing soft tissue infection and lead to early exposure of wounds in burn patients.

Humeral amputation following total elbow arthroplasty.

Total elbow arthroplasty (TEA) is associated with a relatively high complication rate, and exceptionally catastrophic complications might lead to amputation. The purpose of this study was to determine the incidence and aetiology of amputation performed at our institution in upper extremity limbs with a prior TEA. Between 1973 and 2018, 1906 consecutive TEAs were performed at our institution. Upper extremity amputation was performed in seven (0.36%) elbows with five transhumeral amputations and two shoulder disarticulations. The group consisted of five females and two males with a mean age of 64years (range, 37-80). The index TEA had been performed for rheumatoid arthritis (n = 2), rheumatoid arthritis with acute fracture (n = 2), radiation associated nonunion (n = 2), and metastatic cancer (n = 1). Mean follow-up after amputation was three years (range, 3months-5years). Mean time between amputation and TEA was 5years (range, 2months-13years). The indications for amputation included uncontrolled deep infection in six (86%) elbows and tumor recurrence in one (14%) elbow. Only one elbow (14%) was fitted with a prosthesis. Six (86%) patients died at a mean of three years (range, 3months-5years) after amputation. The results of this study highlight a low incidence of amputation after TEA. Most amputations were the direct result of TEA complications, with infection being the most common cause of amputation. Outcomes after amputation are concerning, with poor overall survival and few patients being fit for a prosthesis.

Semi-Automated Control System for Reaching Movements in EMG Shoulder Disarticulation Prosthesis Based on Mixed Reality Device.

Goal: The development of a control system for an electromyographic shoulder disarticulation (EMG-SD) prosthesis to rapidly achieve a task with a reduction in the operational failure of the user. Methods: The motion planning of an EMG-SD prosthesis was automated using measured visual information through a mixed reality device. The detection of an object to be grasped and motion execution depended on the EMG of the user, which gives voluntary controllability and makes the system semi-automated. Two evaluation experiments with reaching and reach-to-grasp movements were conducted to compare the performance of the conventional system when operated using only visual feedback control of the user. Results: The proposed system can more rapidly and accurately achieve reaching movements (32% faster) and more accurate (69%) reach-to-grasp movements than a conventional system. Conclusions: The proposed control system achieves a high task performance with a reduction in the operational failure of an EMG-SD prosthesis user.