The biomechanical demand of the golf swing makes it difficult to reproduce with commercially available prosthetic elbows that aid transhumeral patients in playing golf. A golf swing can be broken down into five steps: takeaway—from ball address to the top of the backswing; forward swing—from the end of the backswing until the club is horizontal; acceleration—from horizontal club to ball contact; early follow-through—from ball contact to horizontal club; and finally, late follow-through—from horizontal club to end of motion.2 Of all the upper body joints, the right elbow on a right-handed golfer does by far the most work during the swing due to a large amount of displacement by the right elbow.3 The upper limb joints account for 25.7% of the work done by the body's joints during a golf swing. Because of this biomechanical reality, transhumeral patients have been forced to swing a golf club one-handed. Our transhumeral golfing prosthesis features a suction socket with a figure-of-eight harness for auxiliary suspension, lightweight tubular plastic with a flexible elbow and a TRS Inc. golfing terminal device (TD). All of these features assist our transhumeral patient by reducing exertion by the sound arm. The elbow is the most crucial component in the prosthesis because it is capable of the complex motion required through takeaway, forward swing, and acceleration of the golf swing. The major advantage of having this prosthesis is the reduction of stress on the sound arm and prevention of overuse syndrome (Figure 1–5).
We did not consider one-handed golfing an option due to the age of the patient and the possibility of elbow injury if the swing involves a lot of compensatory movements to get the club back in the proper plane. First, we used a Utah Dynamic transhumeral total contact suction socket with this style socket trim:
- For additional socket control using anterior and posterior flanges.
- Lateral trim edge distal to acromion allowing for increased range of shoulder abduction.
Because the primary suspension of the prosthesis is suction, this allows for minimal harnessing, decreases loading in the contralateral axilla, and enhances proprioception.4 A figure-of-eight harness was fabricated as an auxiliary suspension, and a tripod was formed from three pieces of 0.5 × 5 inch tubular plastic tubing. The tripod segments were heated with a heat gun until soft and formed around the distal end of the Vivac test socket and secured with fiberglass with 5 to 7 degrees of flexion. This flexion alignment enables the spring not to be loaded before swing begins, thus reducing strain to the sound hand during preparation to begin golf swing. A 1 inch inner diameter rubber hose was the first elbow we tested. It had good flexibility but did not have as much energy return during the swing as we had envisioned. A high-tensile spring was tested with favorable results in flexibility, energy return, and energy expenditure. In permitting a satisfactory arc of motion of the golf club, the best results came with the spring being one-third of the total length of device. Tubular plastic was used for the forearm, with the length depending on the TD and wrist used. Traditional alignment with prosthesis length to sound side thumb tip was used with a traditional right-over-left-hand grip to take all slack from the spring during preclub swing. This will give a distance reference when aligning up a golf shot, allowing for better chance of good ball contact. A Hosmer round wedge grip wrist inner insert unit along with three TRS TDs were used throughout our fittings, leaving it to the patient to decide which he preferred. In addition, the TD was not completely tightened to the wrist unit to allow smooth supination and pronation throughout the golf swing. Ultimately, the TRS Eagle Golf TD was the TD the patient preferred. It was the most comfortable after repetitive golf swings, and with its limited flexion and extension, it enabled him to be able to have better control through acceleration and ball contact. The prosthetic elbow that we incorporated assists in lessening stabilizing energy needed by the sound arm during swing. The TD aids in the amount of energy the sound hand exerts, allowing for the golfer to be able to play longer. The patient was introduced to Ken Juhn, head golf professional at Terrace Hill Golf Club, Tampa Bay, FL, through the amputee Department of Veterans Affairs support team (AVAST) from James A. Haley Veterans' Hospital. AVAST sponsors a golfing clinic where Mr. Juhn was introduced to our patient and commented, “It is incredible—never seen anything like it.”
The patient has given informed consent for use of his image in the figures accompanying this article.
A recreational prosthesis can be critical for the well-being of an amputee. Studies have shown that psychological aspects of an upper-limb amputation and the resulting disabilities are too often considered secondarily when determining what will be the most appropriate prosthesis for an individual patient.5 The patients' psyche is a very important factor when it comes to achieving a positive outcome in any prosthetic treatment. Our patient's goal was to be able to golf with his friends. An unconventional approach and components were needed to achieve this goal. The patient has been golfing with the device for 2 months with great success.
1. Wetterhahn KA, Hanson C, Levy CE. Effect of participation in physical activity on body image of amputees. Am J Phys Med Rehabil
2. Katarina G. Golf Injuries and Biomechanics of the Golf Swing
. University of Umeå, Department of Sports Medicine; 1999. Available at: http://www.improve-golf-swing.com/pdf/biomechanics-of-the-golf-swing.pdf
. Accessed July 8, 2010.
3. Nesbit S, Serrano M. Work and power analysis of the golf swing. J Sport Sci Med
2005;4. Available at: http://www.jssm.org/vol4/n4/18/v4n4-18pdf.pdf
. Accessed July 9, 2010.
4. Bowker JH, Michael JW. Atlas of Limb Prosthetics: Surgical, Prosthetic, and Rehabilitation Principles
. 2nd ed. St. Louis, MO, Mosby-Year Book Company; 1992.
5. Billock J. Upper limb prosthetic management hybrid design approaches. Clin Orthot Prosthet