Shoulder Disarticulation Research Articles

Development of a Shoulder Disarticulation Prosthesis System Intuitively Controlled With the Trunk Surface Electromyogram.

We developed an intuitively operational shoulder disarticulation prosthesis system that can be used without long-term training. The developed system consisted of four degrees of freedom joints, as well as a user adapting control system based on a machine learning technique and surface electromyogram (EMG) of the trunk. We measured the surface EMG of the trunk of healthy subjects at multiple points and analyzed through principal component analysis to identify the proper EMG measurement portion of the trunk, which was determined to be distributed in the chest and back. Additionally, evaluation experiments demonstrated the capability of four healthy subjects to grasp and move objects in the horizontal as well as the vertical directions, using our developed system controlled via the EMG of the chest and back. Moreover, we also quantitatively confirmed the ability of a bilateral shoulder disarticulation amputee to complete the evaluation experiment similar to healthy subjects.

Targeted Muscle Reinnervation and the Volar Forearm Filet Flap for Forequarter Amputation: Description of Operative Technique

Targeted muscle reinnervation after upper-extremity amputation has demonstrated improved outcomes with myoelectric prosthesis function and postoperative neuropathic pain. This technique has been established in the setting of shoulder disarticulation as well as transhumeral and transradial amputations, but a detailed technique of targeted muscle reinnervation with free tissue transfer from the volar forearm after forequarter amputation has not yet been described. Here, we describe a technique using a volar forearm filet flap to achieve simultaneously satisfactory soft tissue coverage after resection of a tumor from the chest wall and targeted muscle reinnervation of the brachial plexus.

Prognosis and outcomes of forelimb amputation in two raccoon dogs

Limb amputation is a salvage surgical procedure relatively common in small animals and other species. Wild animals after forelimb amputation have many difficulties in returning to normal life because forelimbs of arboreal quadrupeds are used to carry most of their weight and hold feed. This study investigated forelimb amputation and its outcomes in two raccoon dogs. Two male raccoon dogs presented for radio-ulnar fractures. Shoulder disarticulation amputation was applied to protect the thoracic cavity and reduce surgical time. After the operation, they could run comparatively faster with three legs. As they had good body condition and regular appetite during the hospitalization period, they were released to the area from which they were captured. Six months after the release, one of the raccoon dogs represented for hair loss by mites. It showed satisfactory function of the existing three limbs. Thus, amputation of forelimb could be considered as a treatment in raccoon dogs with severe limb status.

Targeted Muscle Reinnervation for Partial Hand Amputation

Background:Targeted muscle reinnervation for the treatment of symptomatic neuromas after upper limb amputation has been described for shoulder disarticulation and for transhumeral and transradial amputations. Early clinical outcomes are promising and demonstrate a statistically significant reduction in phantom limb pain and a decrease in residual limb pain.Methods:We performed a cadaver dissection of the motor branches arising from the median and ulnar nerves to assess whether this technique could be applied to symptomatic neuromas after partial hand and finger amputations.Results:After identification of all branches under 4.5x loupe magnification, we performed simulated transfers of digital nerves to lumbrical motor branches, common digital nerves to lumbrical motor branches or the recurrent motor branch, and the common sensory portion of the ulnar nerve to a hypothenar motor branch.Conclusions:The proximity of all sensory nerves to motor branches and the numerous redundant motor nerve targets available support our hypothesis that targeted muscle reinnervation is possible after partial hand or finger amputation. Further studies will be required to refine clinical indications and evaluate outcomes.

Fabric Vest Socket with Embroidered Electrodes for Control of Myoelectric Prosthesis.

Myoelectric prostheses assist users to live their daily lives. However, the majority of users are primarily confined to forearm amputees because the surface electromyography (sEMG) that understands the motion intents should be acquired from a residual limb for control of the myoelectric prosthesis. This study proposes a novel fabric vest socket that includes embroidered electrodes suitable for a high-level upper amputee, especially for shoulder disarticulation. The fabric vest socket consists of rigid support and a fabric vest with embroidered electrodes. Several experiments were conducted to verify the practicality of the developed vest socket with embroidered electrodes. The sEMG signals were measured using commercial Ag/AgCl electrodes for a comparison to verify the performance of the embroidered electrodes in terms of signal amplitudes, the skin-electrode impedance, and signal-to-noise ratio (SNR). These results showed that the embroidered electrodes were as effective as the commercial electrodes. Then, posture classification was carried out by able-bodied subjects for the usability of the developed vest socket. The average classification accuracy for each subject reached 97.92%, and for all the subjects it was 93.2%. In other words, the fabric vest socket with the embroidered electrodes could measure sEMG signals with high accuracy. Therefore, it is expected that it can be readily worn by high-level amputees to control their myoelectric prostheses, as well as it is cost effective for fabrication as compared with the traditional socket.

Wearable fabric sensor for controlling myoelectric hand prosthesis via classification of foot postures

The degrees-of-freedom of robotic prosthetic hands have recently increased, but high-level amputees such as those with shoulder disarticulation and trans-humeral amputation do not have enough muscular areas on their upper limbs upon which to base surface electromyogram (sEMG) signals. In this paper, a wearable fabric sensor is proposed to measure the sEMG on the lower limb and to classify the foot postures by using the proposed convolutional neural network (CNN), ultimately, for the application to high-level upper limb amputees. First, we determined that sEMG signals of the lower limb can be classified into levels in a manner similar to those of the upper limb for eight postures. Second, a multilayer perceptron (MLP) and the proposed CNN was used to compare the pattern recognition accuracy for classifying eight postures. Finally, the wearable fabric sensor and the proposed CNN network were demonstrated by the trans-radial amputees. These results showed that the wearable fabric sensor verified different eight patterns based on similar motions of both limbs (p < 0.001). In addition, the classification accuracy (91.3%) of the proposed CNN was much higher than that (79%) of MLP (p < 0.05). The wearable fabric sensor allowed the measurement location to change from the upper limb to the lower limb and allowed the number of the classifiable patterns to increase thanks to the sixteen-channel sEMG signals acquired from 32 fabric electrodes. The high classification accuracy of the proposed CNN will be useful for various users who have to wear myoelectric prosthesis every day.

Extra-articular resection of shoulder joint for bone sarcomas: Oncologic and limb-salvage outcomes of 32 cases compared with shoulder disarticulation and forequarter amputation.

We aimed to identify the overall survival (OS), surgical complications, survival of reconstruction, and functional outcome of patients who underwent extra-articular resection of the shoulder joint for primary bone sarcomas. The OS and local recurrence rates in patients who underwent an amputation were also evaluated for comparison. Thirty-two patients treated between 1988 and 2017 were studied. The tumours were located in the humerus in 22 (69%) and scapula in 10 patients (31%). The resection types were Malawer type IV in 6 (19%), type V in 21 (66%), and type VI in 5 patients (15%). Reconstruction was performed with endoprosthesis in 23 patients (72%) while excision arthroplasty with the suspension of the humerus to the clavicle was performed in 9 patients (28%). Surgical margins were wide in 16, marginal in 8, intralesional in 3, and not available in 5 patients. During the study period, 40 patients underwent a forequarter amputation and 11 patients underwent a shoulder disarticulation. The 5-year OS for patients who underwent extra-articular resection of the shoulder joint was 42% which was not statistically different compared with that of patients who underwent amputation (5-year OS = 30%; P = .091). The 5-year survival of the reconstruction was 94%, similar for endoprosthesis and excision arthroplasty. Local recurrence and complications developed in 6 (19%) and 10 patients (31%), respectively. Failures of the reconstruction requiring revision surgery occurred in two patients (6%). Limb salvage was achieved in 30 patients (94%). The median Musculoskeletal Tumour Society functional score was 61% (interquartile range, 57%-70%) and was similar in the endoprosthesis and excision arthroplasty group. Extra-articular resection of the shoulder joint for bone sarcomas is an effective limb-salvage method. However, local recurrence remains a principal concern.

Cervical erector spinae plane block catheter for shoulder disarticulation surgery.

Cervical erector spinae plane block catheter for shoulder disarticulation surgery.

Cross-sectional International Multicenter Study on Quality of Life and Reasons for Abandonment of Upper Limb Prostheses.

Background:This multicenter study aimed to examine the reasons for prosthesis rejection and assess the quality of life (QOL) among patients with upper limb deficiency.Methods:Three rehabilitation centers in Japan and 1 academic medical center in the United States participated. Patients between the age of 12 and 75 years with unilateral or bilateral upper limb absence from the level of wrist to shoulder disarticulation were included. Two questionnaires were used, an original questionnaire on prosthesis use and the EQ-5D, which were completed by both the participant and a live-in proxy.Results:Of the 367 patients with upper limb loss invited, 174 patients participated in this study. Eighty percent of the study population were male patients. The most common amputation level was transradial. Trauma was the most common cause of limb loss. The prosthesis rejection rate was 9% (n = 16). The most common reason for abandonment was a lack of prosthesis functionality. Ten of 16 prosthesis nonusers (63%) and 59 prosthesis users (38%) were unemployed or students. The mean EQ-5D utility score was significantly higher in prosthesis users than in nonusers (0.762 versus 0.628, P < 0.01). Live-in proxies significantly overestimated QOL in male patients (0.77 versus 0.807, P=0.01).Conclusions:The current prosthesis rejection rate is low. QOL was significantly higher in prosthesis users than in nonusers. More prosthesis users were employed compared with nonusers. Care should be taken not to overestimate the QOL of male patients with upper limb loss as their proxies often did.

Control methods for upper extremity prostheses

The paper deals with upper extremity prostheses control methods analysis. We consider prostheses control peculiarities for three main levels of amputation (prostheses for hand and fingers amputation, forearm amputation or forearm disarticulation, shoulder amputation or shoulder disarticulation). It is shown how amputation level is connected with used prosthesis control methods. The most perspective control methods for hand and fingers prostheses are the ones with extended feedback and adaptivity. It is beneficial to use neurointerfaces and muscle synergy phenomenon in control methods for forearm prostheses. Non-invasive and intuitive control methods are considered to be the most effective for shoulder prostheses. In spite of a great variety of modern technological achievements, the question of full recovery for all upper extremity functions remains open. A number of still unsolved problems, concerning the development of upper extremity prostheses control systems, is outlined: organization of extended “human – prosthesis”feedback, an effective control of multiple degrees of freedom, and simultaneous usage of the useful signal sources of different origins.

Upper extremity anomalies in children with femoral and fibular deficiency.

Defects occurring in the femoral-fibular-ulnar developmental field are believed to cause the cluster of anomalies seen with femoral, fibular and ulnar limb deficiencies. Upper limb function must be considered in the management of lower limb deficiencies. The purpose of this study is to determine the frequency and type of upper extremity anomalies found in children with femoral and/or fibular deficiency. A retrospective review of 327 consecutive patients with the diagnosis of femoral and/or fibular deficiency was performed using existing records and radiographs. Characteristics of those with and without upper extremity anomalies were compared. Upper extremity anomalies were identified in 56 patients. They were more common among those with bilateral, compared with unilateral, lower extremity deficiencies (P < 0.0001). Seventy-five upper limbs were involved with 50 ulnar deficiencies, nine congenital transhumeral deficiencies, four congenital shoulder disarticulations, seven cleft hands, two radial head dislocations and one each - radial deficiency, syndactyly and capitate-lunate coalition. Two patients with bilateral upper extremity anomalies had ulnar deficiency on one side and a transverse deficiency on the other. Upper extremity anomalies are found in 17% of children with femoral and/or fibular deficiency, especially with bilateral lower extremity involvement. Ulnar deficiency is the most common type but one-third had other anomalies. The frequent finding of congenital transverse upper extremity deficiencies suggests there may be common embryology.

Primary Bone Lymphoma of Humerus Culminated to Shoulder Disarticulation- Astray of Diagnosis

Primary Bone Lymphoma of Humerus Culminated to Shoulder Disarticulation- Astray of Diagnosis

FACTOR ANALYSIS OF UPPER LIMB PROSTHETIC ACCEPTANCE FROM RETROSPECTIVE PROSTHETIC CLINICIAN SURVEY

INTRODUCTION&#x0D; Upper limb prosthetic acceptance seems to be relatively unchanged from 1958 where it was measured to be 75% for transradial, 61% for transhumeral, and 35% for shoulder disarticulation levels. A practitioner survey from 2013 by the author found this to be largely unchanged at 79.6%, 57.8%, and 32.8% respectively. An upper limb meta-analysis showed that the most significant factors affecting prosthetic rejection using a median rating were function, comfort, ease of use, weight, heat, lack of sensory feedback, inconvenience, lifestyle, dissatisfaction with technology, irritation, and availability of services. An earlier survey by the author condensed these factors of rejection to amputation level, functional advantage, and comfort, and included confidence of the prosthetist, availability of therapy, and support of the patient context. Also it was speculated that the value of factors influencing rejection of prostheses may not be simply the converse of those accepting the prosthesis but different scales.&#x0D; Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32045/24459&#x0D; How to cite: Stark G E. FACTOR ANALYSIS OF UPPER LIMB PROSTHETIC ACCEPTANCE FROM RETROSPECTIVE PROSTHETIC CLINICIAN SURVEY. CANADIAN PROSTHETICS &amp; ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32045 &#x0D; Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. &#x0D; http://www.aopanet.org/

Mechanical Design and Assessment of a Low-Cost 7-DOF Prosthetic Arm for Shoulder Disarticulation.

This work presents the design of a low-cost prosthetic device for shoulder disarticulation. A proper design of the mechanisms has been addressed to obtain a prototype that presents 7 degrees of freedom. Shoulder movement is achieved by means of a spherical parallel manipulator, elbow movement is performed by a six-bar mechanism, and the wrist movement is implemented by a spherical parallel manipulator. A set of dynamic simulations was performed in order to assess the functionality of the design. The prototype was built using 3D printing techniques and implementing low-cost actuators. An experimental evaluation was carried out to characterize this device. The result of this work is a prototype that weighs 1350 g that is able to perform movements related to activities of daily living.

Congenital Fibrosarcoma – Case Presentation

Abstract Introduction. Congenital fibrosarcoma is a rare soft tissue neoplasm, distal extremities being more commonly involved. This tumor has a rapid growth and extensive local invasion, but metastasis is rare. It is usually observed in children younger than two years old and is present at birth in up to 30% of the cases. Purpose. Evaluation of the methods of diagnosis and treatment in a case of a newborn known from intrauterine life, with a large tumor of the right arm. Materials and methods. We present the case of a 1-day-old patient, who was transferred from maternity in our clinics with the following diagnostics: large tumor of the right thoracic member, cardiac insufficiency, prematurity, severe respiratory distress. The tumor was visible at ultrasonography from intrauterine life, and the evolution was the increase in volume with necrosis areas and hair presence on its surface. After imagistic investigation, taking into account the tumoral extension with neurovascular involvement, without the possibility of a tumoral resection, but also the imminent danger of spontaneous rupture, we decided to perform a shoulder disarticulation without a biopsy in advance. Results. Postoperative evolution and the treatment of the cardiac insufficiency were good under antibiotics. The histopathological results advocate for the diagnosis of congenital fibrosarcoma, also confirmed by immunohistochemical tests. Conclusions. Soft tissue tumors are very rare and they need a multidisciplinary evaluation for the establishment of the right treatment. Imagistic and laboratory investigations can guide the diagnosis and the therapeutical conduct. The certainty diagnosis is established only after the histopathological results.

Necrotising fasciitis following a supracondylar fracture and an open radius fracture in a child

Background: Necrotising fasciitis is a rare, rapidly progressing soft-tissue infection with a high mortality rate. Historically, necrotising fasciitis has been associated with penetrating injuries, and more recently with immunocompromise and severe comorbidities. This case report highlights the association of necrotising fasciitis in a child with an open distal radius fracture and a supracondylar fracture. Method and results (case report): A 10-year-old boy was admitted 24 hours after falling from a tree with a Gustilo and Anderson grade II distal radius fracture and a Gartland grade III supracondylar humerus fracture. The wound was debrided and the fractures reduced and stabilised with Kirschner wires. Within 48 hours of admission he developed a necrotising fasciitis that extended onto the chest and eventually resulted in a shoulder disarticulation. The tissue defects were covered with flaps and skin grafts and the patient was discharged home. Conclusions: This case highlights the importance of having an early and high index of suspicion for necrotising fasciitis in a child with an open contaminated fracture and delay to both antibacterial chemotherapy and surgical debridement. Tissue trauma due to open fractures may obscure the early skin signs of necrotising fasciitis as well as laboratory risk factors. In the South African context, urgent administration of cephazolin and surgical exploration must be done to prevent the devastating complication of necrotising fasciitis. Level of evidence: Level 5

Targeted Muscle Reinnervation for Transradial Amputation: Description of Operative Technique.

Targeted muscle reinnervation (TMR) is a revolutionary surgical technique that, together with advances in upper extremity prostheses and advanced neuromuscular pattern recognition, allows intuitive and coordinated control in multiple planes of motion for shoulder disarticulation and transhumeral amputees. TMR also may provide improvement in neuroma-related pain and may represent an opportunity for sensory reinnervation as advances in prostheses and haptic feedback progress. Although most commonly utilized following shoulder disarticulation and transhumeral amputations, TMR techniques also represent an exciting opportunity for improvement in integrated prosthesis control and neuroma-related pain improvement in patients with transradial amputations. As there are no detailed descriptions of this technique in the literature to date, we provide our surgical technique for TMR in transradial amputations.

Processing of surface EMG through pattern recognition techniques aimed at classifying shoulder joint movements.

Artificial arms for shoulder disarticulation need a high number of degrees of freedom to be controlled. In order to control a prosthetic shoulder joint, an intention detection system based on surface electromyography (sEMG) pattern recognition methods was proposed and experimentally investigated. Signals from eight trunk muscles that are generally preserved after shoulder disarticulation were recorded from a group of eight normal subjects in nine shoulder positions. After data segmentation, four different features were extracted (sample entropy, cepstral coefficients of the 4th order, root mean square and waveform length) and classified by means of linear discriminant analysis. The classification accuracy was 92.1% and this performance reached 97.9% after reducing the positions considered to five classes. To reduce the computational cost, the two channels with the least discriminating information were neglected yielding to a classification accuracy diminished by just 4.08%.

Effectiveness of Electromyographic Biofeedback, Mirror Therapy, and Tactile Stimulation in Decreasing Chronic Residual Limb Pain and Phantom Limb Pain for a Patient with a Shoulder Disarticulation

Effectiveness of Electromyographic Biofeedback, Mirror Therapy, and Tactile Stimulation in Decreasing Chronic Residual Limb Pain and Phantom Limb Pain for a Patient with a Shoulder Disarticulation

Effectiveness of Electromyographic Biofeedback, Mirror Therapy, and Tactile Stimulation in Decreasing Chronic Residual Limb Pain and Phantom Limb Pain for a Patient with a Shoulder Disarticulation

Background and Purpose: There are 1.3 million people in the United States living with limb loss, and most of these patients experience some form of residual limb pain and phantom limb pain (PLP). The purpose of this case study was to determine the effectiveness of mirror therapy, biofeedback, and tactile stimulation on decreasing chronic residual limb pain and PLP in a patient with an upper-limb traumatic amputation. Case Description: The patient is a 48-year-old male who is employed as a construction worker. The patient was working on a conveyer belt transporting stones when the conveyer belt caught his arm resulting in a shoulder disarticulation. According to the International Classification of Functioning, Disability, and Health (ICF), the patient’s activity limitations included difficulty in sleeping, inability to write, or inability to perform heavy household chores, yard work, cook, or manage his own transportation needs. The patient’s participation limitations included decreased recreational activities with his 15-year-old son, maximum difficulty with sexual activities with his wife, and decreased confidence interfering with his normal social activities. Intervention: Interventions include electromyographic (EMG) biofeedback training to infraspinatus and pectoralis major muscle in short/quick, sustained, and gradual contraction with decreasing sensitivity of electrodes. Treatment strategies also included mirror therapy, scapular proprioceptive neuromuscular facilitation (PNF), high-voltage electrical stimulation, retrograde massage, scar mobilizations, tactile cuing, and soft tissue mobilization. Outcomes: The patient demonstrated a 30% decrease in Disability of the Arm, Shoulder, and Hand (DASH) score, decreased pain with Numeric Pain Rating (NPR) from 9/10 to 3/10, increased amplitude of contraction of infraspinatus and pectoral muscles, decreased sensitivity of myoelectric electrodes, and decreased edema. The patient also reported increased confidence in social interactions with friends and personal interactions with his wife. The patient was also able to participate in recreational activities with his teenage son. Discussion: This case is clinically relevant to the field of physical therapy in terms of decreasing chronic residual limb pain, PLP, and improving muscular control with use of mirror therapy, biofeedback, and tactile stimulation.