Potential Complications of Amputation

Amputation, the loss of a limb or body part, can occur at any age from a variety of causes. It may be the result of a traumatic injury (traumatic amputation) or a scheduled amputation due to a chronic illness such as diabetes (non-traumatic amputation).

In the United States, it is estimated that 350,000 people are living with limb amputation, and approximately 135,000 new amputations are occurring each year. There are several general recommendations for living successfully with a prosthesis, but even so, many people with amputations will experience related challenges:

• phantom pain
• osteoarthritis
• weight gain
• neuromas
• skin breakdown

Phantom Pain

Phantom pain occurs when you still experience sensation or pain in the missing limb. Your pain is obviously not coming from the missing limb but rather from the nerves above the site where the limb was amputated. The brain misinterprets the nerve signals as coming from the amputated limb.

Phantom pain varies and most commonly occurs during the first few weeks following amputation. You may have mild discomfort, an electric shock type of pain, or a burning sensation. Medication may be prescribed to assist you. If your pain is severe, other treatment or surgery may be considered.

Phantom pain differs from pain in your stump or residual limb pain. Pain in your stump can be caused by an improperly fitting prosthesis, or you may have a neuroma. A neuroma is a growth of a nerve tissue.

If you are having pain, visit your physician to discuss your symptoms. Also have your prosthetic specialist adjust or modify your prosthesis as needed to alleviate discomfort.

Osteoarthritis

Osteoarthritis is also called degenerative arthritis or degenerative joint disease. It is a chronic joint disorder characterized by degeneration of joint cartilage and adjacent bone. It causes joint pain and stiffness.

Osteoarthritis usually begins with abnormal cells that synthesize the components of cartilage. The cartilage then grows too much, thins, and develops surface cracks. Cavities form in the bone marrow beneath the cartilage, which weakens the bone. Bone can overgrow at the edges of the joint and produce bumps that can be felt and seen. The bumps interfere with normal function and pain results. Osteoarthritis occurs most often in the knees or lower back.

Proper fit of your prosthesis and gait training are important in preventing osteoarthritis. Physical therapy is often recommended as treatment. Stretching and strengthening, use of analgesics, corticosteroid injections, or surgical joint replacement may also be recommended.

Weight Gain

As a result of amputation, you may experience weight gain. This is usually due to your psychological adjustment and a decrease in physical activity following the amputation. Research by Freidmann indicates that use of a prosthesis requires a 10% increase in energy for a single below knee amputation and much more for multiple amputations.

Though it's important not to overuse the prosthesis, it is equally important to remain active. Consult a nutritional counselor to evaluate the change in your nutritional requirements and the types of exercise you can do.

Be aware that weight gain affects the fit of your prosthesis. If you gain weight, visit your prosthesis specialist for adjustment or modifications.

Neuromas

Neuromas are noncancerous growths of nerve tissue. Neuromas include pinched nerves, nerve tumors, or swollen nerves, which are some common terms for a painful condition.

Neuromas are usually experienced as a sharp pain; it makes you want to rub the area for relief. If the pain becomes more frequent and lasts longer, the nerve becomes enlarged. Consult your physician for treatment. Surgery may be recommended.

Skin Breakdown

A pressure sore, or decubitus ulcer, consists of redness or a break in the skin. It is caused by pressure applied to the skin for too long. The skin eventually dies because blood is prevented from getting to it.

Skin breakdown can result from a poorly fitting prosthesis, excessive activity, or edema or swelling in the stump. If your amputation was due to a burn injury, your skin may be more susceptible to breakdown.

See also: Potential Complications of Spinal Cord Injury.

Recommendations

Here are some general tips for living with a prosthesis.

• Engaging in physical activity, especially in hot weather, can be a problem. It takes more effort with a prosthesis and you may sweat profusely, which causes irritation.
• Keep an emergency kit available, including lotion, an ace rap, Spenco for skin irritations, an Allen key (to tighten parts of the prosthesis), an extra battery (if needed), and extra one-ply socks.
• Be prepared for inclement or unforeseen conditions.
• Use caution in bad weather and use shoes with good treads or a cane for support.
• Regularly check the condition of your prosthesis and keep the phone number of your prosthetist handy.
• Check your skin daily after removing the prosthesis.