houlder Disarticulation Amputation / interscapulothoracic Amputation
Amputations through the glenohumeral and scapulothoracic articulations are uncommon. Tumor control remains the primary indication for amputation at this level despite efforts at limb salvage made possible by more accurate methods of preoperative localization, modern adjuvant therapy, and advances in tissue banking. Serious injury is the next most common cause for limb loss about the shoulder, although fewer than 3% of traumatic amputations of the upper limb occur at these proximal levels. All other causative factors are decidedly rare. Congenital limb deficiencies do occur this far proximally, but as at other levels, the need for surgical revision is rare and usually best avoided.
The loss of upper extremity function following an interscapulothoracic amputation is unquestionably significant. Historically, the prosthetic rejection rate at this level of amputation has been high, due to reasons such as increased energy expenditure, increased weight, increased warmth, decreased socket comfort, poor suspension, and inadequate function. We have successfully implemented a seven-step prosthetic treatment protocol for interscapulothoracic cases. The protocol being the initial evaluation, preprosthetic training, component selection, socket design, alignment and construction, customized programming, and initial training with the prosthesis.