Single-handed, double loaded

During a focus group session, eleven individuals with upper limb absence were asked about their experiences and opinions on factors influencing musculoskeletal complaints. Based on these results a preliminary overview was created with 28 factors mentioned by the participants of the focus group. With a scoping review of the literature, 39 new factors were added to the overview. This created a final overview with 67 factors divided into five main categories.

The results showed that participants of the focus group predominantly mentioned psychosocial factors, such as facilities and social support from significant others and employers. The literature on the other hand, dominantly reported biomechanical factors, such as compensatory movements, posture, and increased load on the unaffected limb. Prosthesis use does not seem to have an effect on musculoskeletal complaints.

Many single-handed individuals suffer from musculoskeletal pain. Central sensitization could be present and could have an influence on the pain. Central sensitization is a neural mechanism defined as increased responsiveness of pain receptors to stimuli that normally would not elicit a pain response, such as touch. Preliminary results indicate that central sensitization may be present in a subgroup of single-handed individuals.

This could give more insight into the role of central sensitization in such individuals, and could aid clinicians in the treatment and prevention of pain complaints in the single-handed population.

In single-handed individuals, activities are performed single-handed or with the help of the remnant limb, with or without wearing a prosthesis. Therefore, they transfer the load to the remaining body structures, often increasing the repetition and force of activities. This can ultimately lead to tissue failure, and as a result, the maximal force decreases and muscle fatigue increases.

Determining the effect on musculoskeletal complaints is clinically relevant for the determination of the duration and type of treatment plan necessary for individuals experiencing musculoskeletal complaints.

Another way to overcome struggles with performing activities single-handed is by using alternative movement strategies and adjusted posture. Additionally, when using a prosthesis extra effort is needed to control the prosthesis. When the compensating movements are suboptimal, this is hypothesized to lead to musculoskeletal complaints.

Investigating how segments/limbs are working together to perform a movement, might help therapists and clinicians to modify movement strategies to be less demanding or to apply an alternative movement strategy with the intention to prevent or decrease complaints.

• Anneliek Peters, PhD student
• Sietke Postema, Rehabilitation physician in training / researcher