Name of the Procedure:

Upper Extremity Addition, Locking Elbow, Forearm Counterbalance (HCPCS Code L6693)

Summary

This procedure involves the addition of a locking elbow mechanism and a forearm counterbalance to a prosthetic upper extremity. It enhances mobility, function, and comfort for individuals with upper limb loss or impairment by providing more controlled movement and support.

Purpose

The procedure addresses difficulties faced by individuals with upper limb amputation or inability to use their natural arm effectively. The goal is to improve the range of motion, strength, and functional use of the prosthetic limb, enhancing the overall quality of life for the patient.

Indications

• Individuals with upper limb amputation or congenital limb differences.
• Patients experiencing discomfort or instability with their current prosthetic elbow.
• Difficulty in controlling or using a prosthetic limb effectively due to lack of elbow support.

Preparation

• Consultation with a prosthetist to determine suitability.
• Custom fitting and measurements of the limb.
• Possible adjustments to medication, but generally no need for fasting.
• Pre-procedure tests might include range of motion assessments and strength testing.

Procedure Description

1. Custom Fitting: The prosthetist takes detailed measurements of the residual limb and the prosthetic socket.
2. Locking Mechanism Addition: Attachment of a specially designed locking elbow joint that allows controlled mechanical locking at various positions.
3. Counterbalance Integration: Installation of a forearm counterbalance system to aid in smooth and effortless arm movements.
4. Adjustments and Calibration: Fine-tuning the prosthetic to ensure comfort and functionality.
5. Patient Training: The patient is educated on how to use, lock, and adjust the new mechanisms.

Tools and equipment used include specialized prosthesis components, alignment tools, and fitting instrumentation. Typically, no anesthesia or sedation is required.

Duration

The fitting and adjustment procedure typically takes 1-3 hours.

Setting

Performed in an outpatient prosthetic clinic equipped for custom fittings and adjustments.

Personnel

• Certified Prosthetist
• Assistant or Technician

Risks and Complications

• Skin irritation or breakdown at the contact points.
• Mechanical failure or malfunction of the locking mechanism.
• Discomfort or improper fit requiring further adjustments.

Benefits

• Enhanced control and stability of the prosthetic limb.
• Increased functional capacity for daily activities.
• Improved comfort leading to higher prosthetic use and acceptance.
• Benefits can be realized immediately or shortly after the fitting and training.

Recovery

• Minimal recovery time due to non-invasive nature.
• Initial discomfort may be experienced as the patient adapts to the new components.
• Follow-up visits for fine-tuning and adjustments as needed.
• Instructions on skin care, use, and maintenance.

Alternatives

• Non-lockable prosthetic joints.
• Electromechanical elbow joints.
• Shoulder-based or harness-controlled prostheses.
• Each alternative varies in terms of control, functionality, and cost.

Patient Experience

Patients may feel initial stiffness or unfamiliarity with the new mechanisms. Pain is usually minimal and managed with over-the-counter analgesics if needed. Comfort measures, continued support, and training sessions significantly aid the adjustment period, leading to a smoother transition and better long-term use.