Prosthetics and Orthotics in Brachial Plexus Injury: Background, Historical Perspective, and Role of Amputation and Prosthetic Fitting

Abstract

Traumatic brachial plexus injuries can have devastating effects on upper extremity function. Historically, prosthetic and orthotic treatment options for brachial plexus injury have varied greatly, with results of treatment being poor to limited. The limited effectiveness relates to the lack of dynamic movement and instability at the glenohumeral segment, affecting bi-scapular abduction, shoulder depression, flexion, and extension required to operate the device. The excursion necessary to generate output greatly exceeds the physiological capacity of the user. With improved surgical techniques, flail arm reconstruction versus amputation offers two different approaches to restore function to pan-plexus-injured patients. With widespread advancement and application of externally powered prosthetic and orthotic components, limited body excursion for patients with upper motor neuron injury can now be accommodated. Proximal stability of the shoulder should be achieved for improved prosthetic and orthotic outcomes. Prosthetic and orthotic technological advances and increased clinical experience in managing patients with upper motor neuron injury have greatly improved the ability to perform bimanual activities, which prevents overuse injury of the sound side and limits compensatory movements, restoring functional outcomes that surpass the previous approach.