Experiences With The Shoulder Saddle Harness At The New Orleans Juvenile Amputee Clinic

Edward T. Haslam, M. D.


It has been our experience that harnessing presents more problems with upper extremity amputees of various ages than any other part of the prosthetic restoration process. Even when the stump is long and the individual has good musculature and joint mobility, and is not too fat, the harness must be fabricated very carefully, or it will not function properly.

In general, we have enjoyed good success with conventional figure-eight harnesses of both the below-elbow and above-elbow type, and more recently with the ring-type harness. It is our feeling, however, that the shoulder saddle and chest strap, or so-called "heavy-duty" suspension harness system, has a definite place in the juvenile armamentarium and may succeed where other methods fail.

The type harness referred to is illustrated on pages 136 and 143 of "Clinical Prosthetics for Physicians and Therapists" (1). We have not attempted to modify this, except in one instance where attempts to use synthetic fabric (orlon) in place of the leather for the shoulder saddle were not found to be successful.

Case One

R.P. was born on January 25, 1955. He had, among his deformities, a right upper transverse partial hemimelia (below-elbow short) and was first fitted at age nine months with a mitten which was kindly made available by the New York University Field Study Group. This was attached to a plastic laminate prosthesis with a split socket and step-up hinges and a half cuff and the elbow was locked at about 100 degrees. Attempts to suspend this prosthesis by means of a modified figure-eight were unsuccessful, since the child was overweight and the stump continually pulled out of the socket.

A shoulder saddle and chest strap with a medial and lateral D-ring suspension was considerably more successful and R.P. has continued to use this type of suspension until the present time. He has continued with the same type of prosthesis, except that normal elbow operation was incorporated when he received his split wafer hook at age two years. He subsequently received larger hooks and more recently an APRL hand (Fig. 1 ). The patient can operate this hand above shoulder level (Fig. 2 ).

Case Two

G.P.J, was born on March 6, 1954. He has a left upper transverse partial hemimelia (below-elbow short), as well as a left lower transverse hemimelia (below-knee). He was first fitted at age 2 1/2 years with a prescription similar to that of Case One, utilizing a hook. G.P.J, has continued with the same prescription with successively larger hooks and is now in the process of being fitted with a hand. He has excellent function, even above shoulder level (Fig. 3 ).

Case Three

J.B., born on February 27, 1949, is a bilateral phocomelia. He was fitted at age nine years and, in his original fitting, an attempt was made to use one of his digits to activate the elbow lock. This was unsuccessful but he was satisfactorily harnessed with an above-elbow shoulder saddle harness. By using a ring and snap arrangement on his chest band, anteriorly, he can apply and remove the prosthesis without assistance.

Case Four

R.E. was born on October 29, 1961. The patient, with a right upper radial paraxial hemimelia, was fitted at age six months with a prosthesis incorporating a rigid elbow and a mitten hand suspended by a shoulder saddle with inside and outside D-ring suspension. At the present time he is using the prosthesis in activities appropriate to his age.

Summary

All of the patients mentioned above were males, but we believe that this harnessing method would also work in a preadolescent female. We have not found these patients handicapped in their ability to use the prosthesis above shoulder level, if their level of amputation made this feasible.

In spite of the fact that the shoulder saddle may be slightly warmer in our climate than the figure-eight straps, we feel that the wider distribution of pressure around the chest strap as compared to axillary loop more than compensates for this.

We have also utilized this method to advantage in two adult cases. The first was a patient with a rheumatic heart disease who had experienced multiple emboli resulting from an amputation of the right arm at mid-humeral level and in a complete left hemiplegia. The circulation in the left arm was such that intense cyanosis developed from the pressure of the axillary loop in the figure-eight harness. This difficulty did not occur with the above-elbow shoulder saddle harness.

The second patient had a long below-elbow stump due to burns which also resulted in a contracture of the axilla on the opposite side. It appeared unlikely that this scar would tolerate the pressure of an axillary loop, so the patient was fitted with a shoulder saddle below-elbow harness as his initial prescription and has worn it satisfactorily for a period of four years.

It is our conclusion that the shoulder saddle is not the best suspension method for universal use but that it should be included in the armamentarium for application in selected cases.

References:
1. Anderson, Miles H., Ed. D., Bechtol, Charles 0., M. D., and Sollars, Ray-Mond E., "Clinical Prosthetics for Physicians and Therapists", Charles C. Thomas, Publisher.