Assessment of an Amputee

History

Baseline Questions

• Age: Record the patient's age.
• Employment: Document their job or occupation.
• Home Circumstances: Note living conditions, support systems, and accessibility.

Details of Amputation

• When: Record the date of the amputation.
• Why: Determine the cause (e.g., trauma, vascular disease, congenital, infection).
• Operations: Ask if there have been multiple surgeries on the stump.
• Complications: Inquire about post-operative issues, such as infection or delayed healing.

Current Symptoms

• Pain:
  • Stump Pain: Nature, onset, relieving factors, and analgesics used.
  • Phantom Pain: Frequency, nature, and treatment.
  • Night or Rest Pain: Assess severity and impact on sleep.
• Neurologic Symptoms: Evaluate sensations like tingling or numbness in the stump.
• Infection:
  • Presence of discharge, redness, swelling, or systemic symptoms.

Prosthetic History

• Prostheses:
  • How many prostheses has the patient used?
  • Why were they changed?
  • What is currently in use?
• Comfort: Is the prosthesis comfortable and functional?

Functional Level

• Current Function: Assess the patient's capabilities and limitations:
  • Sports, walking, climbing stairs, self-care, and driving.
• Changes: Has functional ability recently improved or declined?
• Satisfaction: Is the patient satisfied with their current functional status?
• Problems: Identify specific issues the patient wishes to address.

Additional History

• Past Medical History (PMH): Review for conditions relevant to amputation or prosthetic use.
• Drug History: Document medications, especially those for pain or infection.
• Family History: Investigate genetic or congenital causes if relevant.

Examination

Look

• Orthoses and Aids: Note any orthoses, prostheses, or use of wheelchairs.
• General Mobility: Observe how the patient moves around the room.
• Stump Examination:
  • Scars: Check for redness, swelling, sinuses, or discharge.
  • Muscle Wasting: Assess proximal muscle groups.
  • Stump Shape: Look for pressure areas or abnormal contours.

Feel

• Warmth: Detect signs of inflammation or infection.
• Collections: Palpate for fluid accumulations.
• Sensitivity: Assess for tenderness or pain.
• Tissue Tethering: Check if soft tissues are adhered to the bone.

Move

• Range of Motion (ROM):
  • Evaluate active and passive movement of proximal joints.
  • Note any stiffness or pain.

Gait Assessment in Prosthesis

• Observe gait mechanics while the patient is using their prosthesis.
• Look for asymmetry, compensatory movements, or discomfort.