1. Upper limb prosthesis in PP
Trans humeral amputation
Measurements, Cast and Rectification

2. 1) Patient Examination
Check the passive and active range of movement of the gléno-humeral joint.
Make a muscle testing.
Check that the patient is able to operate straps and fastenings. ( sound upper limb)
Check for any painful areas

3. 2) Measurements : sound side
Axilla or acromion process to olecranon with elbow flexed.
Axilla or acromion process to thumb tip with elbow straight.
Hand size, for cosmetic reasons, the prosthetic hand should be slightly smaller than the sound hand.
Show the patient a selection of suitable hands and hooks prior to the casting stage.

4. Measurement: amputated side
Axilla or acromion process
to end of stump.
Stump circumferences.
if required on an elbow disarticulation patient,
ML measures at and
above epicondyles.

5. Measurement chart

6. Socket design 1) The proximal trim line of the socket passes
over the top of the shoulder girdle.
2) The socket is trimmed below the top
of the shoulder girdle.

7. Socket design 1) The proximal trim line of the socket passes
over the top of the shoulder girdle.
= some weight is taken over the shoulder thus reducing e the load on the harness.
it limits the amount of shoulder abduction.

8. Socket design 2) The socket is trimmed below the top
of the shoulder girdle.
Its allows a greater range of abduction but places a higher load on the harness

9. Socket design
Both designs rely on anterior and posterior wings which extend medially to the line drawn down through the axilla.
Any gapping of the wings reduces their effectiveness.
Before casting , the P&O has to decide which
type of socket will be manufactured.

10. Cast technique A thin casting stockinet is put onto the stump.
Mark any painful or bony areas.
Mark the shoulder girdle's bony prominences as clavicle & acromion process.
Draw the trim lines on the stockinet.
Apply pressure on top of the pectoral
muscles just below the clavicle.

11. Cast technique
Apply proper and even tension of POP bandages during casting.
Cast irregularities make the removal of the cast more difficult.

12. Cast technique: slab cast
Each slab is composed of 3 layers of POP bandage
( width 15cm).
one slab for axilla ( 6 layers)
one slab for the medial wall
one slab for the anterior
one slab for the posterior
one slab for the lateral and shoulder
6. a roll of POP bandage ( 10 cm) is connecting the slabs together

13. Cast technique : slab cast
Each slab should be slightly longer than the stump.
The axilla slab has to be 3 times the length of the axilla.
Start casting by positioning the axilla slab in order to shape the medial trim line.
Then position the medial slab : this slab has to overlap the axilla slab.
During casting, beware of stump abduction.

14. Cast technique : slab cast
The shoulder slab should reach from anterior axilla area to posterior axilla area.
In order to flatten the medial wall, the patient is keeping the stump against the trunk (ribcage).
The sub-clavicular fossa and the clavicle need to be well shaped.

15. Cast technique: slab cast
The cast is removed while the POP bandages have set.
Draw and cut the trim lines.
For an "over the shoulder socket design",
the medial trim line is cut straight above the edge of the axilla.
It allows a good suspension and abduction.

16. Plaster socket fitting
Ensure that the patient can flex and extend stump without rubbing at medial trim line level.
For long stump the medial wall can be lowered ( 1 cm).

17. Plaster check socket
The "wings" should not be wider than half of the distance from the axilla to the corner of the neck

18. Alignment of the negative cast
Lateral and anterior alignement build down line should be marked.
For short stumps (abducted) we can use modified build down line

19. Rectification of the positive cast
Minimal rectification is needed
Ensure that marks and build down lines are transferred to the cast
The distal end does not usually need a build-up

20. Rectification of the positive cast
Ensure that the medial wall has been slightly flattened during the casting process.
This allows the arm to adduct comfortably against the rib cage

21. Rectification of the positive cast
All production measures are taken from the medial trim line at the axilla.
If this trim line is lowered in the case of a patient with a long stump, the amount lowered should be noted as it will affect the production measurements.

22. Rectification of the positive cast
The wings should be smoothened, ensure that the edges flare slightly outwards slightly to prevent them digging into the body.
The acromion and clavicle will need built up