Functional outcome of patients with proximal upper limb deficiency - acquired and congenital

Objective: To investigate the functional outcome of patients with proximal upper limb deficiency - acquired and congenital ( elbow disarticulation, transhumeral, shoulder disarticulation and forequarter level). Design: Cohort observational study. Subjects: All proximal upper limb amputees and patients with congenital upper limb absence currently registered with the Sheffield Mobility and Specialised Rehabilitation Centre. Methods: A self-administered postal questionnaire and medical records were used to collect data. The questionnaire obtained information about demographic details, dominancy of the amputated arm and independence and participation in activities of daily living (ADL), domestic and recreational activities. The prevalence of pain in the phantom limb and stump, and information regarding the remaining arm was also obtained. The Hospital Anxiety and Depression Scale ( HADS) was used to evaluate the psychological state of the subjects. Results: Trauma was the commonest cause of proximal upper limb loss (71.25%). Transhumeral amputation was the predominant level (78.75%). Although 73.2% returned to work following amputation, 66.6% had to change job. Overall rejection rate of prosthesis was 33.75%. Twenty-five per cent of patients found the prosthesis beneficial for driving and a small proportion used the prosthesis for employment and recreational activities, but the vast majority used the prosthesis primarily for cosmesis. Pain in the phantom limb was reported in 60% of our patients but there was no significant correlation between this and depression. Symptoms of overuse injury in the nonamputated limb were higher than expected in the normal population. Conclusion: As many as 33.75% of patients with proximal upper limb deficiency rejected their prostheses and many who continue to wear them do not find them useful in ADL and employment, etc. It is vital that rehabilitation programmes should focus on both prosthetic and nonprosthetic training to achieve maximal independence.