Limb Deformity and Amputation

Limb Deformity
Congenital

Complete/partial absence of a
limb
Overgrowth or undergrowth of
a limb (polydactyly, syndactyly
or Apert syndrome, Marfan
syndrome)
Constriction band syndrome
(entrapment of foetal parts by
fibrous amniotic bands whilst
in utero)

Amniotic fluid band syndrome

Achondroplasia (most
common cause of dwarfism)
Osteogenesis imperfecta
(genetic mutation
characterized by abnormal
collagen formation resulting in
multiple fractures and
deformity)

Limb Deformity
Acquired

Rickets
Trauma
Meningitis
Poliomyelitis

Congenital Limb Deformity

Can be caused by a genetic abnormality,
medication or intrauterine growth restriction
Most prominent example is thalidomide
Treated morning sickness, resulted in limb
deformities

Acquired Limb Deformity

Polio
Can cause temporary
paralysis
Paralytic polio causes
deformities in the hips, ankles
and feet

Rickets;
Osteomalacia in children,
caused my vit D deficiency
Bones are weak
Leads to skeletal deformities

Limb Amputation
The surgical removal of part of the body, it can be a whole limb,
or part of a limb
Some of the reasons for amputation are:
gangrene, as a consequence of PVD
serious trauma to the limb
serious infection, to protect the rest of the body

Outlook for patients following amputation depends on several

factors
age walking with a prosthesis is more physically demanding
how much of the limb was removed
how well they cope with the emotional and psychological impact
of amputation

Following amputation, people have reported feelings of grief

and loss very similar to mourning

Upper limb amputation is less

common than lower limb. It is
often as a result of serious
injury.

Lower limb amputation is

more common, especially in
the elderly. These tend to be
as a result of PVD or diabetes.

Phantom Limb Pain

Following amputation, a person may still have sensations from
the missing limb, it can just be an awareness or it can be painful.
It can be described as burning, aching, as if the hand is being
crushed in a vice
Three potential mechanisms;
The peripheral theory suggests that pain may be the result of nerve
endings around the stump forming into neuromas. These then
generate abnormal impulses which can be interpreted as pain.
The spinal theory suggests that the lack of sensory input leads to
changes in the CNS. This leads to "confusion" in certain regions of
the brain, triggering symptoms of pain.
The central theory proposes that the brain has a "memory" of the
amputated limb and its associated nerve signals, including pain.

Prostheses
Prosthetic limbs are not suitable for everyone, a purely
cosmetic limb may be recommended instead.
If offered a prosthetic limb, patients undergo a series
of activites prior to discharge;
Desensitisation, to make the prosthetic more
comfortable, it consists of the followin steps;
gently tapping the skin with a face cloth
using compression bandages to help reduce swelling
rubbing and pulling the skin around the bone to minimise
scarring

Patients will also undergo physiotherapy to strengthen

the remaining muscles

Prosthetic Legs

Treating Phantom Limb Pain

Research carried out in Liverpool in 2008 found
that if people spent time imagining stretching
out their missing limb this would reduce their
pain.
A similar technique that can be used is known as
mirror visual feedback.
a mirror is used to create a reflection of the other
limb. People then move/massage their remaining
limb and this can relieve pain.

Sometimes analgesics are used or non-invasive

therapies

Living with Limb deformity or amputation

Medical, social models
Psychological model: different activity
limitations because of their cognitions,
emotions, or coping strategies.
Stereotyping
Stigma (felt or enacted)
Depression
Exclusion, isolation

Living with limb deformity or amputation

Adaptations: home, environment

Bathing, washing, personal hygiene
Nourishment
Dressing tree: adaptive donning and doffing
techinques

Any questions?