Provide a helping hand to patients with upper extremity prostheses
Deborah J. Velez MSN, NP
Mary Ellen Dellefield PhD, RN

January 2011 
Volume 41  Number 1
Pages 49 - 52
  PDF Version Available!

BEFORE THE UNITED STATES' involvement in the wars in Iraq and Afghanistan, most upper extremity amputations were related to work-related civilian trauma. Acute care staff nurses rarely cared for patients with an upper extremity amputation.Today, the odds that you'll care for such a patient have increased. In the last 10 years, 1,621 U.S. service members serving in Iraq and Afghanistan have undergone amputations. These include 1,222 major limbs and 399 partial amputations that include hands, feet, toes, and fingers.1 As U.S. veterans return from overseas, you're likely to interact with someone with an upper extremity prosthesis-not only as a patient, but also as a neighbor, friend, or even loved one.You already know how to care for a person with an upper extremity prosthesis regarding basic wound care, the need for psychological support to deal with changes in body image, and the importance of providing emotional support. Knowing the latest technologic developments and the proper terms associated with prostheses can help you participate competently as a member of the interdisciplinary rehabilitation team and interact empathetically with your patient.The complexity of the human hand poses a challenge to researchers working to produce lifelike upper extremity prostheses. Extrinsic and intrinsic muscle groups move hands. The extrinsic muscle groups are long flexors and extensors located in the muscle belly on the forearm. The intrinsic muscle groups arise from the deep flexor and insert on the dorsal extensor hood mechanism. Flexors are used to bend fingers; extensor muscles straighten them.2 (See Inside the hand.)Before 2000, an arm amputation was categorized as below the elbow or above the elbow. The terminology used today reflects how an amputation crosses the axis of a bone. For example, an amputation across the humerus is transhumeral. An amputation across the ulna/radial portion is transradial.3 (See Coming to terms for list of common terms used when talking about

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