Pain in the residual limb
While many amputees experience neuroma pain (NP) or phantom limb pain (PLP), these are not the only sources of pain in your residual limb. Other possible sources include:
Areas of stable skin graft or linear scars are unlikely to cause much discomfort. However, the skin at the edges of your scars may become sensitive with time due to a disturbance of the nerve supply in these areas. This is particularly true if there are neuromas located next to the scars or the scars become hypertrophic or keloid (raised). Sadly, all scars are permanent, but there are options available to treat neuromas, to reduce the size of the scarred areas or to treat hypertrophic and keloid scars.
Folliculitis is a skin condition caused by inflammation of the hair follicles on your residual limb. The inflammation is caused by pulling of the hair follicles as your limb moves around in the silicone liner of your socket. Sadly, surgery is not a particularly effective solution. A better solution is hair removal using:
We advise you not to shave your hairs since this tends to make the hairs grow inwards which may make the problem worse.
Skin cysts can occur if your skin glands (e.g. sweat glands) become blocked. They can also occur with severe folliculitis. In extreme cases, you may develop multiple, painful cysts in the affected area. If this happens, the only solution is to have the cysts removed, surgically.
Ulcers can form wherever your skin is subjected to excessive chafing or pressure. They are painful and often form over bony prominences. They can take weeks or months to heal.
The key to avoiding the pain and stress of cysts and ulcers is prevention. It is important to pay close attention to socket fitting and to ensure that you have done all you can to remove all the hairs on your residual limb.
Bursas can be a painful and persistent issue. They are cavities that form within the residual limb in response to the soft tissues rubbing constantly against a bony prominence. This often occurs over the end of the residual bone and the pain arises when the bursas become inflamed. Your doctor may try to excise the bursa or inject it with steroids to reduce the inflammation. However, once formed, they often recur quickly and these solutions only offer a temporary fix.
There are some other non-surgical solutions for bursas. One is to create a socket that immobilises the end of the bone more effectively or reduces rubbing of the soft tissues over bony prominences. However, these solutions may simply transfer the original problem elsewhere (e.g. transferring weight from the end of the stump into the groin for an above knee amputee results in ulceration of the groin skin).
After an amputation, many patients develop areas of extra bone around the end of the residual bone. It is not entirely clear why this happens, but it is often related to the nature of the injury that caused the amputation. High-energy injuries (e.g. an explosion or bullet wound) often result in extensive heterotopic bone formation.
The bony prominences created by heterotopic ossification can often rub and chafe within a socket, causing pain and discomfort or ulceration of the overlying skin. The solution is simple: remove the heterotopic bone. If the conditions that led to the formation of the heterotopic ossification in the first place do not recur, then the ossification does not return either.
The key to avoiding most of these issues is often prevention. It is important to pay close attention to the needs of your residual limb. For example, being fastidious about hair-removal if you experience folliculitis. You should also ensure you have a well-fitting socket.
However, the only way to resolve socket-related issues and discomfort permanently is osseointegration (OI). With this procedure, you will no longer need to rely on a socket. Find out more here.