Test socket fitting problems.

[mike5plus5]

 I'm hopeful this first trial fitting yesterday is not an indication of what's in my future... Since my arm amputation 11-3-15 was unbandaged I have asked about some type of cover to prevent objects contacting my sensitive residual limb. I was told I needed to leave it uncovered and massage it in order to desensitize it. But a stump shrinker was suggested by some sources so I asked my doctor for one. I never got one. Since my leg amp 1-15-15, the same thing - a shrinker was suggested and I asked my doctor but never got one. On 4-16-15 (1st visit to prosthetist) after he introduced himself, the first thing my prosthetist at Hanger Clinic said was "you need a stump shrinker" and he put one on me. Of course it's a little late to try forming a stump after it has healed for 13 weeks (leg) and 23 weeks (arm). So the arm test socket fit pretty well other than some void air space at the tip, which can be corrected. But getting it off is not doable by myself - yet, and my prothetist also even had a tough time getting it off because of the shape. We never even got the leg stump into the socket because of the 'bell' shaped tip.

Photos of bell shaped stumps are HERE and HERE.

The plan is to use an Ossur Seal Fit liner and Unity foot with a vaccum pump for the leg socket seal. The prosthetist made some modifications to the leg socket while I was there yesterday but it didn't help much toward getting my stump into the socket. Then I am wondering if getting the leg off will be difficult like the arm is, for the same reason - the bell shaped stump?
 My prosthetist said not to worry. But based on all the set-backs and mistakes I've been dealt so far since the accident I can't help but be less than optimistic. Any ideas or words of encouragement would be greatly appreciated at this point.

[stonecutter]

I've never used a shrinker sock, with the exception of right after my initial amputation. When they took it off for the first bandage change it was excruciating - worst pain I had ever experience - and still is. I actually passed out. After that one time I've never even seen a shrinker sock. I've used a tensor bandage for the first couple of years to help with shaping. The thing's approx. 20' long, and there's a certain way you need to wrap it on your stump to protect the circulation. I like it because you can go as snug or as loose as you want.

My first fittings of new prosthetics rarely go 100% smoothly. With all the initial adjustments there just is a point where I need to just see how it's fitting over the course of a day and come back for additional adjustments.

I have no experience with an arm stump, but I have very little concern with the photo of the leg. My stump was very bulbous for about 5 years after my amputation. I did, after 18 years, have to go in for a revision surgery because of the way it atrophied and also because of some really wicked recessed scars and nerve damage all of which left me prone to rogue infection. Things are much better now.

Hang in there. This business of being in the some-assembly-required club takes a lot of patience and effort by us. I know you've had some rough experiences from your other posts, but keep on it - squeaky wheel and all...

[Ann]

Hi Mike. as Trevor says first fittings of new prosthetics don't always go hundred per cent smoothly, there are often adjustments, especially in the early days, so don't be too downhearted with your recent fitting, it does usually settle down especially as the residual limb shrinks down a bit.

Here in the UK it is pretty usual to be given a shrinker sock pretty soon after surgery, it takes a while, but the swelling does go down and make fitting the socket easier. Am noticing in your photo that you are sitting with your knee bent, here in the UK, you'd probably also be encouraged to keep your leg out straight on stump board when sitting which also helps with reducing the swelling, but once you are walking again this will probably reduce itself naturually.

Like Trevor, I had a revision for atrophy only last year and and after the surgery did initially have similar problem with the socket. For a while it was difficult to get on and off, but slight changes in style of socket and the natural reduction in the swelling/shape has made this much easier now some months on.

Take your prosthetist's advice and don't worry too much, in the beginning it does often feel like two steps forward and one step backward sometimes, but it does get better.

[cherylm]

Mike, you've gotten some good advice here...I'm going to echo Trevor and Ann. First fittings are often disastrous...especially "very first fittings on a new amputee." This is where the communication between the prosthetist and the patient becomes essential, as well as your determination to work at walking and using your arm prosthesis. There are many, many adjustments that can be made to help you with putting on and taking off your new limbs, and it may take quite a bit of time to sort out what works best for you. Patience, hard work, and good communication.........keep that in mind.

I never wore an "actual" shrinker on my leg. What I did use was a length of firm stockinette, doubled up and pulled over my stump. I still keep one around for those days when a little pressure feels good, but I have not worn it regularly for many years. I was, personally, quite stunned the first time I saw an official shrinker...I didn't even know such a thing existed!

Your stumps will be changing throughout the rest of your life. They'll swell, they'll shrink, they'll reshape to fit varying sockets. A stump is a living thing...it will evolve just like any other part of your body. Take good care of yours and they'll serve you well!

[mike5plus5]

  Thanks for the reply's everyone! I came home from the clinic with my leg Wednesday. I walked on it for 30 minutes first day and have increased time each day to approx. 1 1/2 hours so far today. All this in approx. 10-15 minute intervals. After ~ 10 min. it would get too painful and I'd take a break. I started this morning out with 1 sock then added an additional sock twice during the day. I'm also having pain in my back where it was broken in the accident but I'm not very concerned at this point. After 6 months of confined to bed / wheelchair only, I expected some pains from the body parts that have not been used in so long. I'm confident all this will work itself out in time. I've been working on the "patience" thing and I think I may fit in with this "some assembly required club" after all .
  HERE is a video of me walking and HERE is a photo of my super-cool leg. It's an Ossur LP Variflex foot with a vaccum pump in it which helps eliminate liner-to-socket loose fit issues. My Ottobock myoelectric hybrid arm and Bebionic myoelectric hand parts seen HERE and HERE have been delivered to the clinic so we will be spending some time on that this coming Wednesday after some minor adjustments to my leg.
 So far I don't see any significant marks on my stump that would suggest a possible future issue. There is a slight red mark on the center front base of the stump where the socket is hurting it a little bit when I extend my knee travel too far backward. I'll mention that to my prosthetist this coming Wed.
 All-in-all, I'm a happy camper with my leg so far. I will get my arm soon, and I'll get a partial June 17 for some front bottom teeth that were broken. Heck, I'll be almost as good as new.
BTW: It took a little getting accustom to being 6 foot tall again - seeing as how I'm scared of heights. LOL

[cherylm]

Looking good, Mike! Just keep an eye on what's going on with your body at this point...you're probably right that your back pain is a result from being "laid up" for so long, but it's also possible that it could be related to your prosthesis fit. So, if it doesn't start clearing up pretty quickly once you're up and moving again, mention it to your prosthetist so they can work on adjusting it for you. Hope the arm also works well for you!

[mike5plus5]

 I went back today and my prosthetist found no reason for the fit etc. to be causing my back pain. He said I should see my doctor. I have an appointment to see my back surgeon on June 23rd already anyway. So if I don't get any relief from the pain soon I'll need to limit myself to light activity until then.
My arm fitting today was not pretty but I was anticipating less than success anyway so...
As I posted before, getting the arm test socket off was a problem. Well, today was even worse. It was so tight he finally had to cut it off with a cast saw (seen on the floor in the linked photo). It left the end of my stump bruised from pressure and a mark from one of the myo-electric sensors was imprinted in my skin for about 30 minutes afterwards. A picture of that is HERE. The bruise is circled in red and the sensor imprint (2 vertical white marks) in green.
My prosthetist will be on vacation next week so I'll be meeting with a different one. That may be a good thing to get a second opinion on all this. Wish me luck...