Transhumeral

OBJECTIVES: We present the case of a young woman cocaine user without other cardiovascular risk factors attended to the emergency service presenting signs of acute arterial ischemia on the right arm. METHODS: An angio-CT of the upper limb was performed, highlighting the occlusion of the radial and ulnar arteries and in addition revealed a floating thrombus in the posterior wall of the aortic arch. RESULTS: The patient underwent urgent surgery with transhumeral thrombectomy and four days later, she underwent surgery to remove the aortic thrombus...

As the demand for prosthetic limbs with reliable and multi-functional control increases, recent advances in myoelectric pattern recognition and implanted sensors have proven considerably advantageous. Additionally, sensory feedback from the prosthesis can be achieved via stimulation of the residual nerves, enabling closed-loop control over the prosthesis. However, this stimulation can cause interfering artifacts in the electromyographic (EMG) signals which deteriorate the reliability and function of the prosthesis...

CASE: A 7-year-old boy presented with osteosarcoma of the ulna that required a transhumeral amputation. The patient completed neoadjuvant chemotherapy before surgery. To prevent bone overgrowth and improved prosthetic fitting, a modified amputation was performed with acute shortening and distal epiphysis preservation. CONCLUSION: In this modified amputation, bone overgrowth was not seen and repeated surgeries for stump shaping were prevented. The modified technique enabled length for the prosthetic elbow and a wide stump for better fitting...

New developments in targeted muscle reinnervation promise better options for treatment of neuropathic pain and improved prosthetic control. For transhumeral amputations, the traditional approach involves an anterior incision to access the median and ulnar nerves and a second posterior incision to access the radial nerve. This is necessitated as exposure of motor branches of the radial nerve distal to the branch to the long head of the triceps is difficult from the anterior approach. Herein, we describe a technique for transferring the radial nerve proper distal to the long head branch to a motor branch to the medial or lateral head of the triceps through internal neurolysis and fascicular transfer...

BACKGROUND: A cohort of patients with traumatic brachial plexus injuries (BPIs) underwent elective amputation following unsuccessful surgical reconstruction or delayed presentation. The results of amputation with and without a myoelectric prosthesis (MEP) using nonintuitive controls were compared. We sought to determine the benefits of amputation, and whether fitting with an MEP was feasible and functional. METHODS: We conducted a retrospective review of patients with BPI who underwent elective upper-extremity amputation at a single institution...

Right-sided diaphragmatic injury is an uncommon sequelae from blunt trauma and may be associated with other severe thoracoabdominal injuries. This injury can be easily missed on initial assessment and a high index of suspicion and clinical judgment is required. Recently, we treated a 25-year-old male inflicted with a right-sided diaphragmatic injury after a left-sided transhumeral amputation sustained from an overturned motor vehicle collision with thoracoscopic exploration and reapproximation.

BACKGROUND: A flail limb can be the result of a traumatic complete brachial plexus lesion. Some patients prefer retaining the flail limb, however some patients feel that a flail limb negatively affects daily life. In these circumstances an elective amputation is sometimes elected, however long-term follow-up, with respect to satisfaction and function is unknown. The aim of this study is to evaluate the long-term outcome of this rare and life changing operation. MATERIALS AND METHODS: 8 patients with a transhumeral amputation performed in 2 specialized medical centers were included...

Controlling several joints simultaneously is a common feature of natural arm movements. Robotic prostheses shall offer this possibility to their wearer. Yet, existing approaches to control a robotic upper-limb prosthesis from myoelectric interfaces do not satisfactorily respond to this need: standard methods provide sequential joint-by-joint motion control only; advanced pattern recognition-based approaches allow the control of a limited subset of synchronized multi-joint movements and remain complex to set up...

AIMS: To determine the relationship between clinic and prosthesis-related characteristics and psychosocial adjustment, activity restriction, satisfaction with the prosthesis and quality of life in myoelectric prosthesis users with upper limb amputation. METHODS: Thirty patients with myoelectric prosthesis users with upper limb amputation took part in this study. The patients' demographic and clinical information were recorded. Psychosocial adjustment, activity restriction and satisfaction with the prosthesis were assessed with Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R)...

Robotic prostheses controlled by myoelectric signals can restore limited but important hand function in individuals with upper limb amputation. The lack of individual finger control highlights the yet insurmountable gap to fully replacing a biological hand. Implanted electrodes around severed nerves have been used to elicit sensations perceived as arising from the missing limb, but using such extra-neural electrodes to record motor signals that allow for the decoding of phantom movements has remained elusive...

BACKGROUND: Current myoelectric prostheses lack proprioceptive information and rely on vision for their control. Sensory substitution is increasingly developed with non-invasive vibrotactile or electrotactile feedback, but most systems are designed for grasping or object discriminations, and few were tested for online control in amputees. The objective of this work was evaluate the effect of a novel vibrotactile feedback on the accuracy of myoelectric control of a virtual elbow by healthy subjects and participants with an upper-limb amputation at humeral level...

Background  Traumatic arthrotomy of the wrist is most commonly detected using the saline load test (SLT); however, little data exists on the effectiveness of the SLT to this specific joint. The use of computed tomography (CT) scan has been validated as an alternative method to detect traumatic arthrotomy of the knee, as the presence of intra-articular air can be seen when there is violation of the joint capsule. Question/Purpose  The purpose of this study was to determine the ability of CT scan to identify arthrotomy of the wrist capsule and compare the diagnostic performance of CT versus traditional SLT...

In recent years surface electromyography signals-based machine learning models are rapidly establishing. The efficacy of prosthetic arm growth for transhumeral amputees is aided by efficient classifiers. The paper aims to propose a stacking classifier-based classification system for sEMG shoulder movements. It presents the possibility of various shoulder motions classification of transhumeral amputees. To improve the system performance, adaptive threshold method and wavelet transformation have been applied for features extraction...

BACKGROUND: We sought to assess whether select domains of the Patient-Reported Outcomes Measurement Information System (PROMIS) significantly correlate with the Disabilities of the Arm, Shoulder, and Hand (DASH) score and the Defense and Veterans Pain Rating Scale (DVPRS) among transhumeral amputees. METHODS: We prospectively administered DASH, DVPRS, and PROMIS (including Upper Extremity, Pain Interference, and Pain Behavior domains) testing to patients presenting for consideration of osseointegration after transhumeral amputation...

Absence of the proximal upper limb, whether congenital or acquired, has a profound impact on quality of life. Targeted muscle reinnervation (TMR) was originally developed to improve functional control over myoelectric prostheses; however, it has also been shown to decrease phantom limb pain and neuroma pain as well as prevent neuroma formation. In children, whose rates of prosthetic use are considerably lower than adults, the effects of amputation on limb function can be devastating. To date, there is very little literature regarding the use of TMR in children...

In active prostheses, it is desired to achieve target poses for a given family of tasks, for example, in the task of forward reaching using a transhumeral prosthesis with coordinated joint movements. To do so, it is necessary to distinguish these target poses accurately using the input features (e.g. kinematic and sEMG) obtained from the human users. However, the input features have conventionally been selected through human observations and influenced heavily by the availability of sensors in this context, which may not always yield the most relevant information to differentiate the target poses in the given task...

Surface myoelectric pattern recognition (sMPR) based control strategy is a popularly adopted scheme for multifunctional upper limb prostheses. Meanwhile, above-elbow amputees (transhumeral: TH) usually have limited residual arm muscles, that mostly hinder the provision of requisite signals necessary for physiologically appropriate sMPR control. Hence, the need to maximally explore the limited signals to realize adequate sMPR control scheme in practical settings. This study proposes an effective signal denoising method driven by Multi-scale Local Polynomial Transform (MLPT) concept that can improve the signal quality, thus allowing adequate decoding of TH amputees' motion intent from high-density electromyogram (HD-sEMG) signals...

Multi-channel Electroencephalograph (EEG) signal is an important source of neural information for motor imagery (MI) limb movement intent decoding. The decoded MI movement intent often serve as potential control input for brain-computer interface (BCI) based rehabilitation robots. However, the presence of multiple dynamic artifacts in EEG signal leads to serious processing challenge that affects the BCI system in practical settings. Hence, this study propose a hybrid approach based on Low-rank spatiotemporal filtering technique for concurrent elimination of multiple EEG artifacts...

Targeted muscle reinnervation (TMR) surgery has been shown to aid in prevention and treatment of neuropathic pain. Technical and anatomical descriptions of TMR surgery for upper extremity amputees (including transradial, transhumeral, and forequarter amputations) have been reported, yet such descriptions of TMR surgery for partial hand amputations are currently lacking. Herein we outline the technique of different types of partial hand amputation TMR surgeries to serve as a reference and guide. A retrospective review was performed by our multi-institutional team to identify clinical cases where partial hand TMR surgeries were performed...

Optimizing prosthetic function and tolerance are key principles of performing an elective upper extremity amputation. It is common for upper extremity amputees to experience issues related to nonoptimal prosthetic control and pain. Targeted muscle reinnervation and regenerative peripheral nerve interfaces in elective transhumeral amputations have been introduced as techniques to address the paucity of signals that may exist for myoelectric control postamputation. These techniques require the denervation of muscle and rely on delayed muscle reinnervation to provide eventual signal amplification for prosthetic function...