Upper Extremity Prosthetics- Transhumeral

Front 1

Name the 5 levels of TH amputations

Back 1

1) elbow disarticulation
2) long TH
3) medium TH
4) short TH
5) Humeral neck

Front 2

Describe the control mechanism for a TR Px

Back 2

single control bowden cable

Front 3

Describe the control mechanism for a TH Px

Back 3

Dual control fair-lead cable which include a split housing, 2 cables (1 for elbow flex and TD and 2nd for elbow jt locking), and 3 fxns

Front 4

Describe the control mechanism for a TH or SD Px

Back 4

Triple control- 1 cable to operate elbow lock (nudge control) 2- controls elbow flexion 3- operates TD

Front 5

the more ______ the TR amputation the less ROM (excursion available)

Back 5

proximal

Front 6

Elbow flexion attachement holds the cable and housing ________ and ________ to mechanical elbow axis

Back 6

anterior/posterior and proximal/distal

Front 7

when EFA is located proximal to elbow axis it will require
more or less force to flex arm?

Back 7

more force to lift arm but will require more excursion to do so

Front 8

when EFA is located distal to elbow axis it will require more or less force to flex arm?

Back 8

less force to lift but it decreases the amount of excursion needed to flex arm

Front 9

where is the proximal base plate and retainer located in a TH socket?

Back 9

25 mm proximal to cut end of humerous. Posterior lateral quadrant of humerous. Never more distal then the cut end of the bone

Front 10

What happens if the proximal base plate and retainer is moved more posterior/distal?

Back 10

Less excursion required to flex elbow. Cable moves closer to elbow, CAS more inf on scapula, force needed increases

Front 11

What happens if the prox base plate and retainer is moved more lateral/proximal?

Back 11

Moves cable anterior to the elbow. More excursion required to flex elbow. CAS superior on scap which means you're not capuring all excursion/body motion that is possible

Front 12

What happens if base plate and retainer are attached distal to cut end of the bone?

Back 12

Pt may c/o anterior distal pressure due to opposing forces

Front 13

What is the body motion required to lock the elbow in a TH design?

Back 13

shoulder abd, extension, depression

Front 14

What is the most commonly used elbow joint for a long TH?

Back 14

Positive locking elbow. E400

Front 15

HOw much excursion is needed to lock/unlock the elbow?

Back 15

5/8-3/4"

Front 16

where is the anterior suspension strap located?

Back 16

Deltopectoral groove

Front 17

What is the sequence of functions for TH TD use?

Back 17

Shoulder flexion (flexion of mechanical elbow), shoulder depression, abd, ext (lock mechanical elbow), and shoulder flex (terminal device operation)

Front 18

What are the trimlines of a ED/ long TH Px?

Back 18

exclude acromion, deltopec groove, lateral border of scap

Front 19

What are the trimlines of a medium length TH Px?

Back 19

Up to acromion, include deltopectoral groove, include lateral border of scapula

Front 20

What are the trimlines of a short TH Px?

Back 20

Include acromion and acromio-clavicular joint, medial to delto-pec groove (25 mm), medial to lateral border of scapula (25mm)

Front 21

What is the fxnal ROM of shoulder flex, abd, extension,

Back 21

0-180, 0-170, 0-50,

Front 22

What is the min shoulder flex ROM while wearing a px to obtain 41/2" of excursion?
What is the min MMT strength?

Back 22

45 degrees.

4

Front 23

If you have b/l amputee, how do you determine the length of arm and forearm?

Back 23

Carlyle formula
.19 x body height= AC-LE
.22 x body ht = LE-TT

Front 24

For a unilat amputee, what msr do you take for the Px length?

Back 24

Acromion to LE.
LE to TT

Front 25

Describe the prosthetists hand position when casting a TH

Back 25

Right hand in axilla. With the left hand- thumb inferior to head of humerous, finger inf to spine of scapula

Front 26

How do you cast for a elbow disartic?

Back 26

Pad above the medial humeral condyle to allow cast to be removed due to the bulbous shape of the limb

Front 27

What is an angulation osteotomy?

Back 27

Procedure to create an angle in humerous to allow for suspension and IR/ER

Front 28

What components are preferred with a TH Px?

Back 28

Aluminum and using a positve locking elbow v. a outside locking hinge (even if that means that the anatomical and mechanical elbow won't match)

Front 29

What are the 4 types of turntables for a postive locking elbow hinge?

Back 29

Standard, internal exiting cable, standard with melt out plug, and IR/ER exiting cable with melt out plug

Front 30

HOw much shoulder flex, abd, and ext should you have in a TH Px?

Back 30

Shoulder flex: 90
" abd: 90
" ext: 30 degrees

Front 31

What 3 alignment marks do you need for a TH design?

Back 31

Coronal, sagittal, and acromion process

Front 32

Where should the coronal aligment line be?

Back 32

should fall 25mm away from the widest point of the body

Front 33

What is the fxn of the turntable on a PLE (positive locking elbow)?

Back 33

Allows rotation thru passive prepositioning. Friction mechanism

Front 34

Where is the sagittal alignment line of a TH check socket?

Back 34

Bisects the long axis of the arm from the acromion process

Front 35

How do you determine cable length for a TH Px?

Back 35

Exended Px arm and pronate the TD. 3mm clearance between hanger and housing

Front 36

How do you determine housing length for a TH Px?

Back 36

Flex Px arm, supinate and open TD

Front 37

What is the fxn of the lateral suspension strap (LSS)?
Where is it located?

Back 37

Main suspensor of Px. Over the apex of the shoulder and slightly anterior.

Front 38

What is the fxn of the anterior suspension strap (ASS)?
Where is it located?
Where is the attachement point for elastic attachement?

Back 38

Assists in suspension and controls ER. Deltopec groove. 2 straps sewn together 1" dacron and 1" elastic Jxn is 25mm inf to clavicle.
Distal section of humerous and not interfering with turntable and medial to elbow lock cable. This position helps keep ASS in deltopec groove and helps prevent ER

Front 39

What is the fxn of the elbow lock strap?
Where is it located?

Back 39

Locks/unlocks elbow
1/2" dacron strap sewn onto ASS. 25 mm to clavicle

Front 40

What is the fxn of the axilla loop?
Where is it located?

Back 40

Main anchor of harness.
Sound side axilla

Front 41

What is the location of the control attachement strap?
Fxn?

Back 41

Inf. 1/3 of scapula
Operation of elbow and TD

Front 42

What is the fxn of the cross point?
Location?

Back 42

inf to C7 and on sound side.
Jxn of all straps

Front 43

What is the fxn of the cross-back strap?
fxn?
Who is it typically indicated for

Back 43

Keeps harness from superior migration and keeps the CAS inf on scap to capture more ROM.
Elastic. Inf. axilla loop to CAS.
Short TH

Front 44

What is the advantage of a ring as your cross point?

Back 44

Allows adjustability and allows it to lie flat on Pt's back

Front 45

What does it mean when someone has an excursion problem?

Back 45

Inabiltiy to get to full TD opened at the mouth

Front 46

Name 8 solutions to a excursion/ unable to open TD at the mouth problem?

Back 46

1) Tighten CAS
2) Check triple swivel. Is the distal end of cable housing hitting triple swivel?
3) Move EFA proximal but this increases force needed
4) Move prox base plate prost and distal
5) Add cross back strap
6) "Z" modifiation. Great for short TH.
7) Dual ring harness-lowering CAS on scapula
8)Expanded cross point- lowers CAS on scap
9) Baja piece- Ring that lowers CAS
10) Check socket fit for loose fit

Front 47

What does it mean when someone has a force problem?

Back 47

Pt is lifting forearm and TD is opening. Requires so much force to lift forearm it's bypassing elbow and opening TD instead.

Front 48

Name 10 solutions to a force problem?

Back 48

1) Check # of rubber bands
2) Move EFA distal
3) Move prox base plate ant/prox
4) Add spring lift assist-coil assisst. Be sure to move EFA to most proximal location.
5) Add second retainer to redirect cable
6) ERGO arm- spring lift assist on whole arm instead of just at elbow joint
7) Shorten forearm
8) Lighter TD
9) Teflon lining/ spectra line- helps decrease friction therefore reduce force
10) Check fair lead for contact.

Front 49

Name the straps on this fig 8 harness

Back 49

Axilla Loop, lateral suspensor strap, elbow lock strap, anterior suspensor strap, extra suspension strap

Front 50

Name the straps

Back 50

CAS, cross back strap(elastic), axilla loop, lateral suspensor and extra suspensor

Front 51

Name 2 advantages of fig of 8 with ring

Back 51

lies flat on pt's back and it adjustble

Front 52

Disadvantages of fig of 8 with ring

Back 52

Straps pivot which causes loss of excursion

Front 53

Name the harness in the 2nd pic from top and name the straps

Back 53

Chest strap with saddle.
Chest strap, ELS, CAS, LSS, ASS

Front 54

Name this fig 8 mod modification and describe

Back 54

Z modification. Continuous strap from hanger of CAS to axilla loop. Same fxn as CBS

Front 55

Why would you use a lateral " Y " strap?

Back 55

When you have a cut out over deltoid region