Rotación interna del hombro: desde una posición de flexión de codo, en un plano

transversal, se
realiza cuando el brazo se acerca al tronco. Este movimiento se frena a los 30º por
choque de masa,
pero si el movimiento continúa, llega a un rango total de movimiento de 95º.
 Rotación externa de hombro: desde una posición de flexión de codo, en un plano
transversal, el
brazo se aleja del tronco. Rango total de movimiento de 80º.
Movimientos especiales del hombro:
 retropulsión
 antepulsión
En estos dos movimientos, se toma como referencia el muñón del hombro, incluyendo
allí articulaciones y
músculos como una estructura corporal punto de referencia. Generalmente estos
movimientos se combinan
con los movimientos puros. Indican la postura, por ejemplo, la
Antepulsión de los dos hombros remite a una hipercifosis.
 Flexión horizontal (también llamada aducción transversal): desde una posición de
abducción de hombro
de 90º en un plano transversal, el brazo es llevado hacia delante. Rango total de
movimiento: 140º
10
 Extensión horizontal (también llamada abducción transversal): desde una posición
de abducción de
hombro de 90º, en un plano transversal, el brazo es llevado hacia atrás. Rango
total de movimiento:
30º
11
AUTOTEST
Seminario: La cintura escapular y el hombro
Preguntas
1) ¿Cómo está compuesta la cintura escapular?
2) Describa sintéticamente los huesos que la componen
3) ¿Cómo está formado el complejo articular del hombro?
4) ¿Qué movimientos posee la articulación glenohumeral?
5) ¿Cuáles son los músculos que movilizan la cintura escapular y el hombro?
6) Describir y explicar rangos articulares de los movimientos del hombro
Target Muscle Reinnervation

Target muscle reinnervation (TMR) is a surgical technique that applies to all upper
extremity amputation patients that are candidates for a myoelectric prosthesis.
This technique involves taking motor nerves that are transected during an
amputation and attaching them to the motor nerves of muscles remaining in the upper
extremity or trunk. This procedure is typically done during the amputation itself
but is possible during revision surgeries as well. It allows for reinnervation of
new target muscles so that signals may transmit to the prosthesis and the patient
can use it intuitively. If the amputation is done in such a way that there are few
residual muscles, then TMR may be performed on trunk muscles instead.[21]

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Complications
Phantom limb pain/sensations: A feeling of pain or sensations in the “missing limb”
may occur; this is likely to be neuropathic and treatment is generally with
neuropathic pain medication such as gabapentin and pregabalin. Other classes such
as opioids, NSAIDs, and acetaminophen are not as effective.
Residual limb pain: This is likely to be musculoskeletal and localized in nature
due to the remodeling of scar tissues, fascia, and muscles. Treatment includes
wound care and systemic medications such as NSAIDs, Acetaminophen, opioids and in
some cases muscle relaxants. Desensitization techniques may also be used such as
compression, tapping, massage, and other modalities.
Edema: Localized swelling is a complication that is very likely to occur in
amputations and has the best outcome when control is started soon after surgery,
with an immediate post-operative rigid dressing (IPROD). In the weeks following
amputation, edema can further be controlled by compressive dressings, massage,
elevation and in patients who have co-morbidities affecting fluid balance, use of
diuretics.
Contracture formation: Contractures are a musculoskeletal condition causing
rigidity or hardening of muscles, tendons or other tissues leading to deformity and
rigidity of joints; this is a long term complication that arises through mechanisms
that are not completely clear. It is thought that decreased neural activation,
protracted placement of a joint with the muscle in the short position and muscle
atrophy are all contributing risk factors for formation.[22] Thus, the management
of this complication involves stretching maneuvers to preserve the range of motion
and strengthening to preserve muscle bulk.
Body Asymmetry: An amputation creates weight distribution changes and can modify
the center of gravity leading to compensatory mechanisms in function and gait,
which can lead to pain, spasms or discomfort in other areas of the body.
Skin Breakdown: In the weeks following an amputation, skin break down at the site
of surgery can occur for a variety of reasons including poor wound healing due to
co-morbidities, excessive bleeding, infection, edema, and poor dressing techniques.
In the long term, this complication may arise due to assistive devices or
prostheses that a patient may use. As a note, it is imperative to help shape the
residual limb into a proper cylindrical or conical shape with smooth edges so that
during prosthetic use, skin breakdown complications decrease.
Cosmetic acceptability: Cosmetic acceptability post amputation can have emotional
and mental side effects on a patient. Using an aesthetically appealing surgical
technique, fitting the patient with a skin tone matched prosthesis, and minimal
bracing may help mitigate this concern.
Neuroma: Over time, as nervous tissue remodels, a mass of soft tissue and nerves
may form. These are often benign but can be painful. Conventional treatments may
include neuropathic pain medications or nerve blocks.[23]