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.
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