Asymmetrie der Haltung und der Rumpfmuskulatur nach einseitiger Armamputation - eine klinische, elektromyographische, haltungsanalytische und rasterphotogrammetrische Untersuchung

Abstract

Unilateral upper limb amputation causes changes in statics of the spine. As a result asymmetrical posture of the spine, muscular asymmetries follow. In this study a population of upper limb amputees (above and below elbow amputees) is examined by clinical, electromyographical analysis and gait analysis. Upper limb amputations cause in correlation to weight loss a shift of the trunk to the side of the amputation, a scoliosis with a bowing to the side of the amputation, an elevation of the shoulder on the amputation side and a torsion of the trunk. Muscular asymmetries result from loss of function (muscles of the arm, M. latissimus, M. trapezius) and by shifting of the center of gravity. In order to get the center of gravity over the legs, the amputee compensates the loss of weight by shifting the upper trunk to the side of the amputation. As a result the shift of the segmental center of gravity at the lumber height to the side of the normal arm with muscular asymmetry in the erector trunci lumbalis results. As well we saw an overactivity of musculus glutaeus medius and resulting stress of the amputation sided hip joint. There was a remarkable difference between above and below elbow amputees caused by differences in weight loss. Muscular and static asymmetries in amputees who lost their arm only a short period before could be reduced by compensating the weight loss. Results for technical orthopaedic fitting and stress on gymnastic procedures to compensate these statistical problems are discussed.

Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors

“…While the BS requires one to keep the CoG over the center of the support base, asymmetric loading of the extremities results in CoG displacement [2, 18, 19]. A similar result was also found in the present study indicating that the average CoG was displaced towards the lymphedema side at an amount of 25% of LOS with 60.6 degrees in the first quadrant of the ellipse shape boundary of the LOS (Fig.…”

“…[2] found that unilateral upper limb amputation also caused CoG displacement toward the normal side and therefore resulted in the development of an asymmetric posture. However, the amputee compensated the loss of weight by shifting the upper trunk to the side of the amputation in order to get the center of gravity over the legs.…”

“…The cause of sway may be described as an active search process to find the best possible position at a given moment, and an output of a control process to maintain this position. However, many factors may play a certain role in degradation of the postural stability by means of increasing postural sway such as disability of the sensory-motor system [1] as well as weight asymmetry such as amputation [2] and unilateral weight carriage [3] or unilateral volume change in the upper body [4]. …”

Biomechanical influences of shoulder disarticulation prosthesis during standing and level walking

“…This effect is known in the literature. 20,21 If a prosthesis is used, clinical impairments such as poor posture, back pain and so on, may be reduced. 20 The study revealed that a standard prosthetic system with a weight of approximately 2.4 kg may reduce this asymmetry by 45% on average.…”

“…This is confirmed by Greitemann. 21 In addition, Greitemann explained that muscular and static asymmetries and poor posture could be reversed by compensation of the weight of the amputated arm under the condition that the treatment had started as soon as possible after amputation. Therefore early prosthetic fitting with adequate physical and occupational therapy is required to minimize long-term effects, such as scoliosis.…”