Diagnostic ultrasound of the residual limb: A narrative review.

Globally, 57.7 million people lived with traumatic limb loss in 2017, with the prevalence of amputation in the United States alone expected to reach 3.6 million by 2050. Pain is a common complication after limb loss, with up to 59% of patients experiencing residual limb pain (RLP). Although RLP is often due to a structural etiology, it is difficult to treat because the exact structure involved is frequently not apparent on history and physical examination alone. This narrative review aims to summarize the available literature on diagnostic ultrasound of the residual limb and examine the utility of ultrasound in identifying specific pathology. A total of 31 peer-reviewed manuscripts published between 1989 and 2021 were included, grouped by pathology. Although ultrasound presents a promising and cost-effective approach to identifying pathology within the residual limb, many gaps remain in the current knowledge, and no specific protocol for a sonographic assessment of the residual limb has ever been proposed. Future studies of diagnostic ultrasound of the residual limb should focus on replicable sonographic techniques and standardized exam protocols.

Current and emerging prostheses for partial hand amputation: A narrative review.

Partial hand amputation can have a tremendous range of impact and functional loss on a person's life. One solution to improve function and address some of the problems that partial hand amputees face is to fit them with a prosthesis. Partial hand prosthetic devices range in a wide spectrum in both function and aesthetics. At this time, there is no one, perfect prosthetic device that can replace what is lost. Many individuals with partial hand amputation require more than one prosthetic device. In this review article, we explored and compared several prosthetic options that have been investigated and marketed by researchers and companies. Some of these options include passive, body-powered, activity-specific, and externally-powered prostheses. Lastly, we described our experiences with partial hand prostheses at Walter Reed National Military Medical Center.

Isolated Mononeuropathy From Rucksack Palsy: A Case Series.

Although there is increasing awareness of brachial plexopathy secondary to rucksack use, isolated mononeuropathies have been less well described. Three cases of mononeuropathy secondary to rucksack use in military personnel are presented, including injuries to the long thoracic and spinal accessory nerves. We also review several different factors in the proper construction, components, and fitting of the rucksack that should be considered in order to prevent rucksack palsy and provide a concise suggestion for rucksack use and education.

The Utility of Dynamic Movement Orthoses in the Management of Complex Regional Pain Syndrome-A Case Series.

Complex regional pain syndrome (CRPS) is a relatively rare, but debilitating condition that may occur after limb or peripheral nerve trauma. Typical symptoms of CRPS include swelling, allodynia, hyperalgesia, and skin temperature changes. Although a variety of pharmacological and non-pharmacological approaches are commonly used in caring for individuals with CRPS, they are frequently ineffective and often associated with side effects and/or additional risks. Previously, elastomeric orthotic garments have been shown to decrease neuropathic pain, reduce edema, and increase proprioception, but no previous reports have described their use in treating CRPS. Accordingly, this case series describes our experiences using a Lycra-based, custom-fabricated Dynamic Movement Orthosis (DMO) as a novel treatment to reduce the symptoms of CRPS and promote function. Four patients were included in this case series, all of whom had very different causes for their CRPS, including a combat-related gunshot injury resulting in multiple foot fractures with a partial nerve injury, a post-metatarsophalangeal fusion, an L5 radiculopathy, and a case of post-lower leg fasciotomies. These four patients all reported subjective improvement in their pain, function, and exercise tolerance in association with their DMO use. All patients demonstrated reduced use of analgesic medications. The pre- and post-DMO lower extremity functional scale showed clinically significant improvement in the two patients for which it was obtained.