Disclosures: Chandni B. Patel, DO: No financial relationships or conflicts of interest

Case Diagnosis: Unilateral Total Shoulder Disarticulation

Case Description: A 40-year-old previously healthy, right-hand dominant male was evaluated by a multidisciplinary team at the rehabilitation amputee clinic via telemedicine after a right total shoulder disarticulation due to a compound humeral fracture following MVA. The patient was planned for targeted muscle reinnervation (TMR) surgery, which was cancelled due to the COVID-19 pandemic. After complete healing of the residual limb, the patient was fitted for a body-powered prosthesis. Of note, the patient previously worked as a welder and expressed maintaining the ability to weld as his primary goal. Muscle pattern recognition evaluation was completed revealing adequate EMG activity in residual limb and muscle flap. Patient underwent planning for a full myoelectric prosthetic elbow, wrist, and hand.

Setting: Veterans Affairs Medical CenterAssessment/

Results: For our patient, planned TMR was cancelled due to the COVID-19 pandemic and subsequent team discussions deemed residual limb function to be adequate for a myoelectric prosthesis based on pattern recognition testing.

Discussion: Prosthesis options for patients with total shoulder disarticulation include body-powered or myoelectric prosthesis. Amputations at the level of the shoulder offer limited residual muscle making it challenging to have a functional prosthesis. For this reason, TMR, transferring of nerves from amputated limb to new muscle targets, is often conducted to offer signals to a myoelectric prosthesis. However, there should be careful consideration in patient selection and timing of TMR during a patient’s course.

Conclusion: The patient will continue extensive rehabilitation and evaluation of the myoelectric prosthesis for functionality, especially in welding. While TMR is increasingly relied on for myoelectric use, the patient did well despite it not being available. Planning for prosthesis requires a multidisciplinary team approach to better evaluate the patient’s residual limb functions and choosing prosthesis to align with patient goals.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/prosthesis-planning-for-unilateral-total-shoulder-disarticulation-using-pattern-recognition-via-telemedicine-in-setting-of-covid-19-pandemic/