title: Fluctuating residual limb volume accommodated with an adjustable, modular socket design: A novel case report.
abstract: BACKGROUND
  This novel case report describes the problems of prescribing a prosthetic socket in a left transfemoral amputee secondary to chronic patellofemoral instability compounded by complex regional pain syndrome. Case Description and Methods: Following the amputation, complex regional pain syndrome symptoms recurred in the residual limb, presenting mainly with oedema. Due to extreme daily volume fluctuations of the residual limb, a conventional, laminated thermoplastic socket fitting was not feasible. Findings and Outcomes: An adjustable, modular socket design was trialled. The residual limb volume fluctuations were accommodated within the socket. Amputee rehabilitation could be continued, and the rehabilitation goals were achieved. The patient was able to wear the prosthesis for 8 h daily and to walk unaided indoors and outdoors.
  
  
  CONCLUSIONS
  An adjustable, modular socket design accommodated the daily residual limb volume fluctuations and provided a successful outcome in this case. It demonstrates the complexities of socket fitting and design with volume fluctuations. Clinical relevance Ongoing complex regional pain syndrome symptoms within the residual limb can lead to fitting difficulties in a conventional, laminated thermoplastic socket due to volume fluctuations. An adjustable, modular socket design can accommodate this and provide a successful outcome.
authors.affiliation: 1 University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: Kay
authors.initials: K
authors.lastname: Mitton
authors.affiliation: 2 SACM, University Hospital of South Manchester, Manchester, UK.
authors.forename: Jai
authors.initials: J
authors.lastname: Kulkarni
authors.affiliation: 1 University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
authors.forename: Kenneth William
authors.initials: KW
authors.lastname: Dunn
authors.affiliation: 3 LIM Innovations, San Francisco, CA, USA.
authors.forename: Anthony Hoang
authors.initials: AH
authors.lastname: Ung
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000379:methods* / Q000534:rehabilitation; D000672:Amputation Stumps / Q000503:physiopathology*; D001186:Artificial Limbs; D002908:Chronic Disease; D018450:Disease Progression; D004487:Edema / Q000503:physiopathology; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D010147:Pain Measurement; D046788:Patellofemoral Pain Syndrome / Q000175:diagnosis* / Q000601:surgery; D011474:Prosthesis Design / Q000379:methods*; D017755:Prosthesis Fitting / Q000379:methods*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Prosthetic design; complex regional pain syndrome; prosthetics; rehabilitation; rehabilitation of amputees