Challenging Case Study: An Upper Extremity Prosthesis For Hypoplasia
Janet G. Marshall, CPO/LPO
A seven year old patient presented with hypoplasia of the right upper extremity having a fused elbow and a single non-functional single digit. The shoulder motion was within normal range and strength. He had never worn a prosthesis, but expressed a strong desire to have a functional hand The challenge was unique in several more aspects, one being that the arm had an extremely small diameter from the shoulder down. This made matching it to the sound side cosmetically more difficult. Suspension would also need a creative solution dealing with such a small dimension and no elbow. Fortunately the forearm was asymmetrical and allowed an inner pelite sleeve to be molded that could create a gripping characteristic aided by the patient's ability to flex his digit slightly. A double wall construction was designed having the inner wall flexible to accommodate this pelite liner. By using this technique for the suspension, the outer wall could mirror the sound side in size and shape, as long as a shirt sleeve concealed the transition from above the elbow. A voluntary close Litetouch TRS hand was the terminal device with a figure nine harness.
The patient, accompanied by one of his parents, was admitted for one week of occupational therapy. His animated enthusiasm for learning and ability to follow all of the instructions enabled him to become proficient with the basic skills. The ingredient that the patient was the main impetus for wanting a prosthesis that "worked", made the fitting more of a success.
Shriners Hospital for Children, Tampa