An amputee poses happily
Life with an arm amputation

Amputation rehab: What to expect

The rehabilitation process is critical for anyone who has recently lost a hand or arm. Find out how the process can help heal your residual limb, restore your mobility, and prepare you for a prosthetic arm.

Overview

Healing, training, and preparing for a prosthesis

After your amputation surgery, recovery and healing are your top priorities. The rehabilitation process is an essential part of this time. Together with your care team, you’ll focus on rebuilding your strength, carefully caring for your residual limb, and taking the first steps toward using a prosthetic arm. 

Amputation rehab begins as soon as possible after your operation, and typically lasts about six months. During that time, your care team will create a detailed plan to heal your residual limb and get you ready for a prosthesis. You’ll also need to start preparing yourself for everyday life with your new upper limb difference. 

We've outlined some of the key steps in that process. Keep in mind everyone’s experience will be different. Your care team will help you understand which activities are most important for you. 

Recommended Steps to the Rehabilitation Process:

  • Heal your residual limb as quickly and successfully as possible

  • Strengthen parts of your body affected by your amputation

  • Prepare you to use a prosthetic device*

*These recommendations focus on devices for users who have had a transhumeral amputation. If you have had a different procedure, your prosthetist can provide you with more information on higher amputation levels.

Managing swelling

Reducing edema in your residual limb

The first steps in amputation rehab begin immediately after your operation. In the days after amputation surgery, your hospital care team will closely monitor your wound, carefully watch for any sign of infection, and ensure that your residual limb begins to heal properly.

One of the most important changes your care team will focus on is swelling, or “edema.” Edema is a normal reaction to an amputation operation, and will typically go down over time. But if it lasts too long, it can slow down your healing and make it harder to fit a prosthesis. Right after surgery, you and your care team will start working together to make sure any swelling goes down over time.

Edema therapy

After the operation, the tissue around the residual limb will usually swell up at first. This swelling, referred to as edema, is a normal reaction to the operation. It usually subsides after a week. Only a loose wound dressing is applied until the sutures are removed. No pressure can be applied to the residual limb at first.

The circumference of the residual limb should be measured regularly to evaluate the swelling. The same measuring points must be used consistently, and the results must be documented on measurement forms. If neglected, the results are not comparable with each other and there is no way to tell if the swelling is decreasing.

After the operation, the tissue around the residual limb will usually swell up at first. This swelling, referred to as edema, is a normal reaction to the operation. It usually subsides after a week. Only a loose wound dressing is applied until the sutures are removed. No pressure can be applied to the residual limb at first.

The circumference of the residual limb should be measured regularly to evaluate the swelling. The same measuring points must be used consistently, and the results must be documented on measurement forms. If neglected, the results are not comparable with each other and there is no way to tell if the swelling is decreasing.

Correct positioning

Pronounced swelling of the residual limb for an extended period of time interferes with wound healing, and delays the time for a prothesis fitting. You should assume a proper posture, even in the hospital bed, to prevent shortening and stiffening of the muscles and joints. Patients usually assume a comfortable and pain-free position at first, but experience has shown that this is not always optimal. As time progresses, the residual limb should lie in an extended position as far as possible. Permanently elevating it – for example, on a pillow – always has to be avoided, otherwise the muscles will shorten and the subsequent mobility of the residual limb is reduced.

Mobilization

Move your residual limb several times a day. Doing this can prevent a loss of mobility in your joints. Early mobilization is important because it activates the circulation and promotes balance. Ask your therapist to demonstrate movement exercises that are right for you at the respective time. The shoulder joint in particular has to be mobilized as early as possible; otherwise, it can become stiff. With a combination of correct positioning and movement, you can properly prepare your arm for wearing the prosthesis.

Compression therapy

Early compression therapy

After the operation, a wound dressing is applied and changed at regular intervals. Compression therapy begins after that, for example, with a compression bandage. Your doctor will determine the exact timing. The purpose of compression therapy is to reduce the residual limb edema and prepare your residual limb for your subsequent prosthesis. Residual limb compression helps optimize the fitting of your prosthesis. Compression also promotes blood circulation in the residual limb. This reduces pain and promotes scar healing.

Training exercises

Preparing to use a prosthetic arm

While you and your care team are working to manage any post-surgical swelling in your residual limb, you’ll also start taking the first steps toward using a prosthesis

These steps typically include:

  • Strengthening and stretching muscles in your residual limb, shoulder, back, and torso

  • Any training you may need to use your remaining hand and arm (your “sound side”) in new ways

Here are a few key areas you and your care team will probably focus on.

Positioning your residual limb

After surgery, you’ll naturally want to put your residual limb in the most comfortable, least painful position possible. You may rest it on a pillow or prop it up in some way.

While this may help reduce your pain at first, it can also cause your remaining arm muscles to shorten and stiffen. This can limit the amount of mobility you’re able to achieve later on. Over time, your hospital care team will encourage you to leave your residual limb extended by your side as much as possible when you’re not exercising or caring for it.

Strengthening your residual limb

As soon as possible after your surgery, your care team will also encourage you to start moving your residual limb a few times every day. This exercise can help improve your mobility, balance, and circulation, and also help you achieve the greatest range of motion possible once you start using a prosthesis.

It’s particularly important to get your shoulder moving again (if possible), because it may otherwise stiffen and limit your ability to move your arm. Your care team will show you how to move and position your residual limb in ways that best support your recovery, healing, and preparation for a prosthesis.

Strengthening supporting muscles

As you start to move your residual limb again, you may notice that having an upper limb difference can affect other parts of your body too. 

For example, it’s normal to feel some strain on your back. That’s because your body’s weight and balance have shifted and your muscles need time to get used to the change. 

You can help by regularly exercising your upper body, shoulders, torso, and legs. Doing so can help your body adapt to its new balance, strengthen important muscles that support your residual limb, and set you up for greater independence after your recovery.

Training your sound side

After you lose a hand or arm, you may soon find you need to rely on your remaining limb in many new ways (especially if you’ve lost your dominant hand). 

As you work on strengthening your residual limb, your care team will also show you some useful ways to build new skills on your sound side. These may include important daily activities – like brushing your teeth, typing, or using a smartphone – that you may want to be comfortable doing one-handed.

Skin & scar care

Supporting your healing wound

In most cases, amputation wounds close in three to four weeks before forming a scar. But while your scar may look like it has healed after a few weeks, the full healing process takes much longer – typically about 18 months.

During that time, caring for your skin and scar is a top priority. A few key steps can help you ensure your residual limb heals successfully, and that it’s ready for a prosthesis when you’re ready to start using one.

In the hospital, the nursing staff and doctors took care of your residual limb by cleaning the wound and changing the bandages or dressings. In the rehabilitation phase, you now care for your residual limb, the scar and also your sound arm yourself. Being able to wear your prosthesis without problems requires ongoing, intensive care.

Desensitising the skin

The skin on the residual limb is often very sensitive after the amputation. You can take various steps to address this. Always use materials that are comfortable for you and work from the end of the residual limb towards the body.

Desensitizing your skin

After your amputation, the skin on your residual limb may be uncomfortably sensitive. There are a few ways you can reduce that discomfort:

  • Gently rub or tap your skin with a soft brush or a spiky massage ball. This will help slowly increase the amount of pressure your skin can take. 

  • Gently rub down your residual limb with a bath towel or washcloth.

  • Whichever you try, always start at the end of your residual limb and work toward your body.

An orthotic and prosthetic professional uses a massage ball on an amputees residual limb to desensitize their skin

Cleaning your skin

Keeping your residual limb clean is also very important. Wash it every day with lukewarm water and an unscented, skin-friendly soap. 

Ottobock offers several care products that can help you clean your skin or scar. Or, you can ask your prosthetist for recommendations.

An amputee cleans their residual limb

Caring for your scar

Regularly moisturize your scar and the skin around it. Scars can’t produce the moisture that typically keeps your skin soft and flexible, which is essential when you start wearing a prosthesis. Prosthetics and rough, dry skin can be a painful combination, one that makes it much harder for you to consistently wear your device.

Unscented moisturizing creams are often a good choice. Ask your prosthetist for their recommendation. They’re always the best place to start when you need advice on how to get the most out of your prosthesis!

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