Name of the Procedure:

Common Name(s): Upper extremity prosthesis addition
Technical/Medical Term: Upper extremity addition, frame type socket, above elbow or elbow disarticulation (HCPCS Code: L6688)

Summary

This procedure involves adding a frame-type socket to an upper extremity prosthesis. It's designed for individuals who have had an amputation above the elbow or through the elbow, providing them with a more stable and functional prosthetic limb.

Purpose

Medical Conditions or Problems:

• Amputation above the elbow or elbow disarticulation due to trauma, congenital abnormalities, or medical conditions like cancer.

Goals/Expected Outcomes:

• To provide a stable and functional prosthetic limb that improves daily living activities.
• To enhance the user's mobility and overall quality of life.

Indications

Specific Symptoms or Conditions:

• Absence of the upper limb above the elbow or through the elbow.

  Patient Criteria:

• Patients who have undergone above-elbow amputation or elbow disarticulation.
• Individuals seeking improved prosthetic function and stability.

Preparation

Pre-procedure Instructions:

• No fasting required.

• Maintenance of general health and proper wound healing if post-surgical.

  Diagnostic Tests/Assessments:

• Physical examination and measurement of the residual limb.
• Assessment of the patient’s overall health and prosthetic needs.

Procedure Description

Detailed Steps:

1. Initial Consultation: A detailed consultation to understand the patient’s needs and goals.
2. Measurement and Molding: Taking precise measurements and possibly creating a mold of the residual limb to ensure a proper fit.
3. Frame Fabrication: Crafting the frame-type socket using lightweight, durable materials.
4. Fitting and Adjustment: Fitting the socket to the residual limb and making necessary adjustments for comfort and functionality.
5. Training and Rehabilitation: Training the patient on how to use and care for the prosthesis.

Tools, Equipment, and Technology:

• Measurement tools, molding materials, fabrication tools, and prosthesis fitting devices.

Anesthesia or Sedation:

• Typically, no anesthesia or sedation is needed as this is a fitting procedure.

Duration

The entire process from initial consultation to final fitting may span several weeks, with each fitting session lasting 1-2 hours.

Setting

The procedure is performed in a prosthetic clinic or specialized outpatient facility.

Personnel

Healthcare professionals involved:

• Prosthetist
• Rehabilitation specialists
• Occasionally, occupational therapists for functional training.

Risks and Complications

Common Risks:

• Minor discomfort or irritation at the contact points.

  Rare Risks:

• Skin breakdown or sores due to improper fit.
• Allergic reactions to materials.

Possible Complications:

• Improper fit requiring adjustments.
• Reduced function if not correctly aligned.

Benefits

Expected Benefits:

• Improved stability and functionality of the prosthetic limb.
• Enhanced ability to perform daily activities.
• Greater comfort and satisfaction with the prosthesis.

Realization Time:

• Benefits can typically be realized shortly after the final fitting and adjustment, with gradual improvement as the user adapts.

Recovery

Post-procedure Care:

• Regular cleaning and maintenance of the prosthesis.
• Frequent follow-up appointments to ensure proper fit and function.

Expected Recovery Time:

• Immediate use after fitting; full adaptation may take a few weeks.

Restrictions/Follow-Up:

• Minimal restrictions; follow-up appointments as advised by the prosthetist.

Alternatives

Other Treatment Options:

• Endoskeletal or exoskeletal prostheses with different socket types.
• Use of advanced myoelectric prostheses.

Pros and Cons of Alternatives:

• Endoskeletal/Exoskeletal: Generally more lightweight but may not offer the same stability.
• Myoelectric: Offers advanced control but can be more expensive and require more maintenance.

Patient Experience

During the Procedure:

• Minimal discomfort during measurement and fitting.

After the Procedure:

• Initial adjustment period with potential minor irritation.
• Pain management through over-the-counter analgesics if needed.
• Emphasis on gradual adaptation and comfort measures.