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Encyclopedia > Phantom limb
Phantom limb
Classifications and external resources
ICD-10 G54.6-G54.7
ICD-9 353.6
This article is about the syndrome. For the fictional character, see Phantom Limb

A phantom limb is the sensation that an amputated or missing limb is still attached to the body and is moving appropriately with other body parts ( Mitchell 1871; Melzack 1992; Ramachandran & Hirstein 1998). Approximately 50 to 80% of amputees experience these phantom sensations in their amputated limb, and the majority of these people report that the sensations are painful (Sherman, Sherman & Parker 1984). Phantom sensations and phantom pain may also occur after the removal of body parts other than the limbs, e.g. after amputation of the breast, extraction of a tooth (phantom tooth pain) or removal of an eye (phantom eye syndrome). The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following codes are used with International Statistical Classification of Diseases and Related Health Problems. ... The International Statistical Classification of Diseases and Related Health Problems (commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... This article is about the syndrome. ... Partial hand amputation For the song Amputations by Death Cab for Cutie, see You Can Play these Songs with Chords Amputation is the removal of a body extremity by trauma (also referred to as avulsion) or surgery. ... A limb (from the Old English lim) is a jointed appendage of the human or animal body; a large or main branch of a tree; a representative, branch or member of a group or organization. ... Human anatomy or anthropotomy is a special field within anatomy. ... This article is about the syndrome. ... This article is about the syndrome. ... This article is about the syndrome. ... Amputation is the removal of a body extremity by trauma or surgery. ... This article is about the syndrome. ... Phantom pain may occur virtually in any of the extremities of someones body after having had an amputation of the respective part. ... The phantom eye syndrome refers to phantom phenomena, such as phantom pain in the eye and visual hallucinations, after the removal of an eye (enucleation, evisceration). ...


Phantom pains can also occur in people who are born without limbs and people who are paralyzed ( Ramachandran 1993; Saadah & Melzack 1994). Phantom pains occur when the missing limb causes discomfort. Other induced sensations include warmth, cold, itching, squeezing and burning ( Ramachandran & Blakeslee 1998; Ramachandran & Hirstein 1998). The missing limb often feels shorter and may feel as if it is in a distorted and painful position. Occasionally, the pain can be made worse by stress, anxiety and weather changes. A congenital disorder is a medical condition or defect that is present at or before birth (for example, congenital heart disease). ... Paralysis is the complete loss of muscle function for one or more muscle groups. ... This article is about the syndrome. ... This article is about the syndrome. ... Look up Pain in Wiktionary, the free dictionary. ... An itch (Latin: pruritus) is a sensation felt on an area of skin that makes a person or animal want to scratch it. ... Burning may refer to any of the following: Combustion The use of a CD burner The Burning Man festival Burning-in of Photographic paper Immolation An insult (slang term) This is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ... This article is about the syndrome. ... This article is about the syndrome. ... In medical terms, stress is a physical or psychological stimulus that can produce mental or physiological reactions that may lead to illness. ... Anxiety is an pleasant complex combination of emotions that includes fear, apprehension and worry, and is often accompanied by physical sensations such as palpitations, nausea, chest pain and/or shortness of breath. ...

Contents

Clinical description

Although not all phantom limbs are painful, patients will sometimes feel as if they are gesturing, feel itches, twitch or even try to pick things up. For example, Ramachandran and Blakeslee describe that some people's representations of their limbs don't actually match what they should be, for example, one patient reported that her phantom arm was about "6 inches too short" (Ramachandran & Blakeslee 1998). This article is about the syndrome. ...


Some people with phantom limbs find that the limb will gesticulate as they talk. Given the way that the hands and arms are represented on the motor cortex and language centers, this is not surprising. Some people find that their phantom limb feels and behaves as though it is still there, others find that it begins to take on a life of its own, and doesn't obey their commands.

I placed a coffee cup in front of John and asked him to grab it [with his phantom limb]. Just as he said he was reaching out, I yanked the cup away.
"Ow!" he yelled. "Don't do that!"
"What's the matter?"
"Don't do that", he repeated. "I had just got my fingers around the cup handle when you pulled it. That really hurts!"
Hold on a minute. I wrench a real cup from phantom fingers and the person yells, ouch! The fingers were illusory, but the pain was real - indeed, so intense that I dared not repeat the experiment.

—Ramachandran, Phantoms in the Brain, p. 43. (Ramachandran & Blakeslee 1998) This article is about the syndrome. ...

Neurological basis

Until recently, the dominant theory for cause of phantom limbs was irritation in the severed nerve endings (called "neuromas"). When a limb is amputated, many severed nerve endings are terminated at the remaining stump. These nerve endings can become inflamed, and were thought to send anomalous signals to the brain. These signals, being functionally nonsense, were thought to be interpreted by the brain as pain.


Treatments based on this theory were generally failures. In extreme cases, surgeons would perform a second amputation, shortening the stump, with the hope of removing the inflamed nerve endings and causing temporary relief from the phantom pain. But instead, the patients' phantom pains increased, and many were left with the sensation of both the original phantom limb, as well as a new phantom stump, with a pain all its own (Ramachandran & Blakeslee 1998). In some cases, surgeons even cut the sensory nerves leading into the spinal cord or in extreme cases, even removed the part of the thalamus that receives sensory signals from the body. This article is about the syndrome. ... The mechanism of the reflex arc In the nervous system, afferent neurons--otherwise known as sensory or receptor neurons--carry nerve impulses from receptors or sense organs toward the central nervous system. ... The Spinal cord nested in the vertebral column. ... To meet Wikipedias quality standards, this article or section may require cleanup. ...


In the early 1990s, Tim Pons, at the National Institutes of Health (NIH), showed that the brain can reorganize if sensory input is cut off (Pons et al. 1991). Hearing about these results,V. S. Ramachandran realized that phantom limb sensations could be due to "crosswiring" in the somatosenory cortex, which is located in the postcentral gyrus ( Ramachandran & Blakeslee 1998; Ramachandran & Hirstein 1998), and which receives input from the limbs and body. Input from the left side of the body goes to the right hemisphere and vice versa. The input from extremities comes into the somatosensory cortex in an ordered way, the representation of which is referred to as the somatosensory homonculus. Input from the hand is located next to the input from the arm, input from the foot is located next to input from the hand, and so on. One oddity is input from the face is located next to input from the hand. The National Institutes of Health (NIH) is the primary agency of the United States government responsible for medical research. ... This article is about the syndrome. ... Dr. Vilayanur Ramachandran on an episode of PBSs NOVA Television program. ... The lateral postcentral gyrus is a prominent structure in the parietal lobe of the human brain and an important landmark. ... This article is about the syndrome. ... This article is about the syndrome. ... Basic Definition Specifically: A physical representation of the primary sensorimotor cortex, i. ...


Ramachandran reasoned that if someone were to lose their right hand in an accident, they may then have the feelings of a phantom limb because the input that normally would go from their hand to the left somatosensory cortex would be stopped. The areas in the somatosensory cortex that are near to the ones of the hand (the arm and face) will take over (or "remap") this cortical region that no longer has input. Ramachandran and colleagues first demonstrated this remapping by showing that stroking different parts of the face led to perceptions of being touched on different parts of the missing limb (Ramachandran, Rogers-Ramachandran & Stewart 1992). Through magnetoencephalography (MEG), which permits visualization of activity in the human brain (Yang et al. 1994), Ramachandran verified the reorganization in the somatosensory cortex. This article is about the syndrome. ... Magnetoencephalography (MEG) is the measurement of the magnetic fields produced by electrical activity in the brain, usually conducted externally, using extremely sensitive devices such as SQUIDs. ... This article is about the syndrome. ...


Treatment

Some treatments include drugs such as antidepressants. Spinal cord stimulation (SCS) can be effective treatment for phantom pain. An electrical stimulator is implanted under the skin, and an electrode is placed next to the spinal cord. The nerve pathways in the spinal cord are stimulated by an electric current. This interferes with the impulses travelling towards the brain and lessens the pain felt in the phantom limb (Melzack 1992). Instead, amputees feel a tingling sensation in the phantom limb. Oral medication A medication is a licenced drug taken to cure or reduce symptoms of an illness or medical condition. ... An antidepressant is a medication used primarily in the treatment of clinical depression. ... The Spinal cord nested in the vertebral column. ... The article on electrical energy is located elsewhere. ... An electrode is a conductor used to make contact with a nonmetallic part of a circuit (e. ... Nerves (yellow) Nerves redirects here. ... Electric current is by definition the flow of electric charge. ... In animals, the brain, or encephalon (Greek for in the head), is the control center of the central nervous system. ... This article is about the syndrome. ...


Vibration therapy, acupuncture, hypnosis and biofeedback may all be used to treat phantom pain but are often of little help. The pain can sometimes be helped by keeping busy and focusing attention on something else. Massaging the stump can sometimes help. Oscillation is the variation, typically in time, of some measure as seen, for example, in a swinging pendulum. ... This article concerns the health profession. ... Acupuncture (from Lat. ... Professor Charcot was well-known for showing, during his lessons at the Salpêtrière hospital, hysterical woman patients – here, his favorite patient, Blanche (Marie) Wittman, supported by Joseph Babiński. ... Biofeedback mechanism. ...


For planned amputation, phantom pain can reduced by preoperative pain management, effective control of pain by analgesic or neuroleptic is required. The brain seems to implant the sensations from the preoperative state. An analgesic (colloquially known as a painkiller) is any member of the diverse group of drugs used to relieve pain (achieve analgesia). ... The term antipsychotic is applied to a group of drugs used to treat psychosis. ...


One particularly novel treatment for phantom limb pain is the mirror box developed by Ramachandran and colleagues (Ramachandran, Rogers-Ramachandran & Cobb 1995). Through the use of artificial visual feedback it becomes possible for the patient to "move" the phantom limb, and to unclench it from potentially painful positions. Repeated training in some subjects has lead to long-term improvement, and in one exceptional case, even to the complete elimination of the phantom limb between the hand and the shoulder (so that the phantom hand was dangling from the shoulder). This article needs to be cleaned up to conform to a higher standard of quality. ... This article is about the syndrome. ...


More recently, virtual reality has been used to combat the discomfort caused by phantom limb syndrome, [1]. Scientists from the University of Manchester have shown that phantom limb pain can be relieved by attaching the sufferer's real limb to an interface that allows them to see two limbs moving in a computer-generated simulation. This works on a similar principle to the mirror box technique in that the somatosensory cortex is being ‘tricked’, except that the illusion is stronger. This article is about the simulation technology. ... The University of Manchester is a large university located in Manchester, England. ... To meet Wikipedias quality standards, this article may require cleanup. ...


See also

This article needs to be cleaned up to conform to a higher standard of quality. ... Neuropathy is a disease of the peripheral nervous system. ... Phantom pain may occur virtually in any of the extremities of someones body after having had an amputation of the respective part. ... The phantom eye syndrome refers to phantom phenomena, such as phantom pain in the eye and visual hallucinations, after the removal of an eye (enucleation, evisceration). ... Synesthesia (also spelled synæsthesia or synaesthesia, plural synesthesiae) -- from the Greek syn- meaning union and aesthesis meaning sensation -- is a neurological condition in which two or more bodily senses are coupled. ...

References

  • Halligan, P.W. & Berger, A. (1999), "Phantoms in the brain", British Medical Journal, vol. 319, pp. 587-588
  • Halligan, P.W. (2002), "Phantom limbs: The body in mind", Cogntive Neuropsychiatry, vol. 7, no. 3, pp. 251-268
  • Halbert, J., Crotty, M. & Cameron, I.D. (2002), "Evidence for the optimal management of acute and chronic phantom pain: a systematic review", Clin J Pain, vol. 18, no. 2, pp. 84-92, PMID 11882771
  • Melzack, R. (1992), "Phantom Limbs", Scientific American, no. April, pp. 120-126
  • Mitchell, S. W. (1871), "Phantom limbs", Lippincott's Mag Popular Literature & Science, vol. 8, pp. 563-569
  • Pons, T. P., Garraghty, P. E. & Ommaya, A. K., et al. (1991), "Massive cortical reorganization after sensory deafferentation in adult macaques", Science, vol. 252, no. 5014, pp. 1857-1860
  • Ramachandran, V. S., Rogers-Ramachandran, D. C. & Stewart, M. (1992), "Perceptual correlates of massive cortical reorganization.", Science, no. 258(5085), pp. 1159-1160
  • Ramachandran, V. S. (1993), "Behavioral and magnetoencephalographic correlates of plasticity in the adult human brain.", Proc. Natl. Acad. Sci., vol. 90, pp. 10413–10420
  • Ramachandran, V. S., Rogers-Ramachandran, D. C. & Cobb, S. (1995), "Touching the phantom.", Nature, no. 377, pp. 489-490
  • Ramachandran, V. S. & Rogers-Ramachandran, D. C. (1996), "Synaesthesia in phantom limbs induced with mirrors.", Proceedings of the Royal Society of London, no. 263(1369), pp. 377-386
  • Ramachandran, V. S. & Blakeslee, S. (1998), Phantoms in the brain: Probing the mysteries of the human mind., William Morrow & Company, ISBN 0-688-15247-3
  • Ramachandran, V. S. & Hirstein, W. (1998), "The perception of phantom limbs: The D.O. Hebb lecture.", Brain, vol. 9, no. 121, pp. 1603-1630
  • Saadah, E. S. & Melzack, R. (1994), "Phantom limb experiences in congenital limb-deficient adults.", Cortex, no. 30(3), pp. 479-485
  • Sherman, R. A., Sherman, C. J. & Parker, L. (1984), "Chronic phantom and stump pain among American veterans: results of a survey.", Pain, no. 18, pp. 83-95
  • Yang, T. T., Gallen, C. C. & Ramachandran, V. S., et al. (1994), "Noninvasive detection of cerebral plasticity in adult human somatosensory cortex.", Neuroreport: An International Journal for the Rapid Communication of Research in Neuroscience, no. 5(6), pp. 701-704

Scientific American is a popular-science magazine, published (first weekly and later monthly) since August 28, 1845, making it the oldest continuously published magazine in the United States. ... Dr. Vilayanur Ramachandran on an episode of PBSs NOVA Television program. ... Dr. Vilayanur Ramachandran on an episode of PBSs NOVA Television program. ... Dr. Vilayanur Ramachandran on an episode of PBSs NOVA Television program. ... Dr. Vilayanur Ramachandran on an episode of PBSs NOVA Television program. ... Dr. Vilayanur Ramachandran on an episode of PBSs NOVA Television program. ... Dr. Vilayanur Ramachandran on an episode of PBSs NOVA Television program. ...

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