Definition

Upper limb amputations are devastating occurrences for individuals, with profound functional and vocational consequences. In the United States, overall, there are approximately 1.7 million people living with a limb loss, or approximately 1 of every 200 people. In contrast to lower limb loss, upper extremity amputation is much less frequent, affecting approximately 41,000 persons, or about 3% of the US amputee population. The etiologies for limb loss are also different. The primary reason for upper limb loss in adults is trauma; cancer is the next most common cause. Other causes of upper limb loss include infections, burns, and congenital deformities.

Dysvascular disease, a frequent cause of lower limb amputations, is primarily related to diabetes and peripheral arterial diseases; lower extremity dysvacular amputations occur in 45 per 100,000 individuals and disproportionately affect minority individuals. Dysvascular disease rarely affects the upper limbs.

The rates for traumatic amputations have declined over the last four decades, probably because of changing work force patterns and greater concerns for industrial occupational safety. Finger amputations are the most common of upper limb amputations and mostly involve single digits.

Upper limb amputations from trauma occur at a rate of 3.8 individuals per 100,000; finger amputations are the most common (2.8 per 100,000). Hand amputations from trauma occur at a rate of 0.02 per 100,000. Excluding finger amputations, traumatic transradial (forearm) and transhumeral (humerus) are the most common upper limb amputations.

In an analysis of the National Trauma database between the years 2000 and 2004, upper limb amputations were more likely to be seen than lower limb amputations in motor vehicle crashes. Motorcyclists and pedestrians were more likely to sustain a lower limb amputation. Machinery, power tools (involving saws or blades), explosions, self-inflicted injury, and assaults are among the most common reasons for traumatic upper limb amputations. Men are at far greater risk for traumatic amputation than women are, demonstrating about 6.6 times the female rate for minor amputations of the finger and hand.

As a result of wars in Afghanistan and Iraq, the number of catastrophic injuries due to explosive devices has increased. Traumatic amputation is the major reason for upper extremity loss in the military. As of July 2011, 14% of major limb loss sustained in Operation New Dawn, Operation Iraqi Freedom, and Operation Enduring Freedom involved the upper extremity. Between October 1, 2001 and July 30, 2011 there were 225 active military who suffered upper extremity amputations. Of those 225, 11 (7%) were isolated bilateral upper extremity amputees.

Transradial amputations were the most common upper extremity amputation levels (47%) and elbow disarticulations were the least common (2.1%). Electrical burn is an uncommon cause of upper extremity amputation. Heating causes coagulative necrosis, and the passage of the electrical current through the tissues causes disruption of cell membranes. Limb loss from trauma occurs at a rate of 0.1 per 100,000.

Limb amputations that result from malignant neoplasms have declined approximately 42% from 1988 to 1996. Their rates of occurrence are lower than for trauma, with an upper limb loss rate in 1996 of 0.09 per 100,000. These rates of upper limb amputations are lower than the incidence rates of lower limb dysvascular amputations due to diabetes and peripheral arterial diseases, which occur in 45 per 100,000 individuals and disproportionately affect minority individuals.

As of September 2010, there were 1219 major limb and 399 partial limb amputations.

Rates of prosthetic rejection are high among upper limb amputees. Persons sustaining upper limb amputations present complex rehabilitative needs that are ideally best managed in a rehabilitation center with therapists, prosthetists, and physicians possessing specialized knowledge and experience. Proper rehabilitation and a comfortable and functional prosthesis will facilitate functional restoration. Vocational counseling and vocational retraining are vital aspects of any program, as this condition often afflicts young, vocationally productive persons, primarily men. A continuum of care is vital to successful rehabilitation. Patients must be transitioned effectively from the inpatient postsurgical unit, sometimes to an inpatient rehabilitation unit, and always to a long-term outpatient rehabilitation and prosthetic program.