There are various ways to deal with disabling physical trauma to an arm.
An injury to where the primary nerves of the arm have been severed results in a condition known as a ‘flail arm’. It’s a complete lack of mobility and sensation of the arm. An injury that causes flail arm usually involves trauma to the shoulder or neck.
Although blood typically continues to flow through the limb, it is useless and cannot be repaired. The muscles of the arm, chest and shoulder soon begin to waste away and the arm swings loosely at the side like a literal “dead weight”.
Surgeons usually recommend amputation soon after the initial injury but it is understandable that patients choose not to amputate while they are still coming to terms with the trauma of losing a limb.
For many patients, the choice not to amputate a flail arm soon after the injury is made purely for the sake of having an aesthetically pleasing appearance, but from a therapist’s point of view it can hold many side effects that include dislocation of the shoulder joint, severe pain, shooting or burning sensation in the arm, development of scoliosis and even musculoskeletal imbalance.
In a study with six patients who suffered complete nerve lesions, it was found that a high level amputation through the arm with an arthrodesis (fusing) of the shoulder joint offered the best functional result, not to mention the relief of the dead weight of the useless arm. In my experience, patients who have undergone the procedure have rehabilitated much quicker and with more success once they have been fitted with a myo-electric prosthesis.
Myo-electric prosthesis, which is controlled by electrical signals generated by your own muscles, offers the ultimate combination of function and natural appearance. With advancements in the field, these prostheses have amazing capabilities, such as elbows that can flex and extend with signals from a pectoral and trapezius muscle or from harness switches.
You can, for example, reach for beverages or food to bring it to your mouth or use the arm as an opposition post to fix objects so that you can manipulate them with your sound arm.
Although amputation remains the decision of the patients and their families, prosthetic technology can offer a whole new world of rehabilitation possibilities especially when it is felt that the patient has not shown sufficient recovery.
Heinrich Grimsehl is a prosthetist in private practice and a member of the South African Orthotic and Prosthetic Association (SAOPA). email: info@hgprosthetics.co.za
