UPPER EXTREMITY PROSTHETIC DEVICES

There are approximately 10,000 new upper extremity amputations in the United States every year.

The two most common causes of upper extremity amputations are trauma (cut, tear, burn, freeze) and surgery (performed to remove a diseased or useless part of the body). It has been found that 75% of the upper extremity amputations in adults are caused due to some kind of trauma such as motor vehicle accident, machinery accident, gunshot wound or electrical burns.

Our specialized upper extremity prosthetists have an in-depth understanding of an upper extremity amputee’s unique needs. Having extensive exposure working with a variety of upper extremity amputation levels along with the techniques and technology which help make upper extremity prosthetic users successful, our practitioners provide unparalleled patient experiences and outcomes.

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Upper Extremity Amputations

There are several different types of upper limb amputations and each type of amputation can impact the type of prosthetic device or prosthetic technology you are a candidate for and ultimately choose/need. An upper limb amputation is the removal of part of the fingers, hand, forearm or arm. An experienced prosthetist may be consulted to establish what amputation level is most favorable for your future prosthetic device. The amputation level factors into what kind of prosthesis is most suitable. Depending on the level of your upper limb amputation (arm, hand, or finger), your ability to use certain prosthetic technologies can vary greatly.

What are the different amputation levels for an upper extremity?

Click on a level below to read more.

When an amputation is limited to the finger(s) or thumb, it’s commonly referred to as a partial finger or partial thumb amputation. For a partial finger or partial thumb amputation, the amputation levels could include:

DIP (Distal Interphalangeal Joint – finger tip)

PIP (Proximal Interphalangeal joint – mid finger)

MCP (Metacarpal Phalangeal joint – entire finger)

Metacarpal amputation refers to a removal of part of the hand and, but not the wrist joint itself. This type of amputation could leave the patient with portions of their hand and fingers still intact and a prosthetic device may or may not be needed.

Wrist disarticulation refers to the removal of the entire hand and the wrist joint. With a wrist disarticulation, prosthetic options can vary, but typical prostheses will have a socket that attaches to a variety of different terminal devices, like a hand or hook. Adaptors and other connecting elements are often required. With the addition of high definition silicone gloves coverings, the entire prosthetic system can be disguised.

Transradial amputations are when the amputation level occurs through the radius and ulna of the lower arm, between the elbow and wrist joint. Prosthetic options for transradial amputations can vary tremendously, but typical transradial prostheses will consist of custom fabricated sockets, which intimately fit the residual limb, a forearm section that may contain electronics and attach to a terminal device, like a hand or hook. Transradial prostheses come in many variations, including passive, body-powered, myoelectric, hybrid systems and activity specific prostheses.

Elbow disarticulation is when the amputation level is at the elbow joint, and the lower arm is removed while the entire upper arm (humerus) is maintained. Prostheses for elbow disarticulation typically consist of a prosthetic elbow joint and socket, in addition to a terminal device(s) that attaches to the socket.

Transhumeral amputation is when the amputation level is through the humerus, above the elbow. Prostheses for transhumeral amputations commonly consist of a prosthetic elbow joint and socket, in addition to a terminal device(s) that attaches to the socket.

Several prosthetics solutions are available for this level of amputation including passive, body-powered, myoelectric, hybrid systems and activity specific systems.

Shoulder disarticulation refers to an amputation/level where the arm bone (humerus) is removed from the rest of the shoulder. With a shoulder disarticulation, a prosthetic system consists of a socket, a prosthetic shoulder joint, a prosthetic elbow joint, and a terminal device(s) that attaches to the socket. Working closely with a prosthetist who understands the complexity and has experience at fitting this level of amputation is crucial for positive outcomes. Several prosthetic solutions are available for this level of amputation including passive, body-powered, myoelectric, hybrid systems and activity specific systems.

Also known as an “intrascapular thoracic” amputation, the forequarter amputation is when the entire arm and shoulder are removed, as well as the scapula and clavicle. With a forequarter amputation, a prosthetic system consists of a socket (which could include ribs or upper portions of the trunk), a prosthetic shoulder joint, a prosthetic elbow joint, and a terminal device(s) that attaches to the socket. Several prosthetic solutions are available for this level of amputation including passive, body-powered, myoelectric, hybrid systems and activity specific systems.

Choosing an Upper Extremity Prosthesis

The human arm and hand are complex structures, for each amputation level we often recommend multiple terminal devices or multiple prosthetic devices to meet the individual’s needs. We recommend that each individual chooses the best tool for the job or activity in which they are involved, in order to have the best possible outcomes.

We provide several prosthetic options for upper extremity amputation levels.

Myoelectric / External Power

A myoelectric upper extremity prosthetic device is powered by a battery system and is controlled by electromyography (EMG) signals generated during muscle contractions received through electrodes mounted in the socket. These signals are sent to a motor in the prosthetic elbow and/or wrist. A myoelectric elbow may then bend or straighten, a wrist can flex, and a hand can open or close. There are many different types of myoelectric prostheses produced by various manufacturers. The advantages of a myoelectric prosthesis is that there is an unlimited functional envelope; it offers functional cosmetic restoration; it can increase a person’s grip force to 20-32 lbs; and the harness system is reduced or eliminated, which offers comfort and increased range of motion.

realistic silicon hand frabrication

Passive Functional / Cosmetic

A passive functional or cosmetic upper extremity prosthetic device is similar in appearance to the non-affected arm or hand and replaces what was removed. It provides simple aid in balancing and carrying. The advantages of this type of prosthesis is that it can be cosmetically appealing; lightweight; simple to use; there is little maintenance; they are great for partial hands and provides opposition.

Partial Hand and Finger

Finger and partial-hand amputees are among the most common type of prosthetic patients seen. However, it was not until recently that a variety of options became available for these prosthetic devices. Playing an important role for amputees, these prostheses offer gripping options and counter-support when grasping objects.

Passive Functional Restorations constructed of silicone and designed to meticulously match the patient’s residual fingers or hand. These silicone prostheses allow for grasping and holding, blend flawlessly with natural skin, can be used all day through a variety of activities and are easy to care for. WCBL has an on-site fabrication lab with in-house Anaplastologists who will create a high realism custom silicone prostheses to flawlessly match a patients natural skin. These are best for light duty usage. Click here for more information.

Activity Specific Devices designed to meet the work or recreational needs of the patient. These needs could range from typing to playing musical instruments to playing sports, and more.

Externally Powered Devices are battery powered and can be configured to address any or all five missing digits. These devices are controlled by either myoelectric (sensors against the skin that pick up electrical signals emitted by muscle movement) control or touch pads. These devices allow patients to grasp and object while conforming to the objects shape, mimics the grip of the human hand with multiple operating modes, allows for gradual increase in grip strength on an object. These are best for medium duty activity usage.

Body Powered Devices and positionable fingers are designed to give patients more functional usage of their prosthetic device.

X-Fingers are designed for a patient who has the bottom portion of their finger remaining, which is used to control the prosthetic device. As the residual finger bends forward it causes the prosthetic finger joints to bed as well.

M-fingers  are designed for a patient who is missing their entire finger. The device works through flexion and extension of the patient’s wrist, which in turn activates the device. In extension, the fingers open and remain that way until the patient flexes their wrist, causing the fingers to close.

The Naked Prosthetics finger uses the remaining length of your amputated finger to control prosthetic finger flexion. With a variety of finger prostheses, Naked Prosthetics provides grip strength, length, and dexterity allowing patients to easily perform their favorite every day activities like gardening, typing, working with tools and many others.

The Titan Finger is designed to work with a full or partial finger amputation and is made from titanium. It allows the patient to manually lock the joints in a secure and functional position while grasping an object. These devices are best for heavy duty work and play usage.

Adaptive / Recreational

A recreational or adaptive upper extremity prosthetic device is customized for a specific function or recreational activity. There are various adaptive devices available for activities such as skiing, golf, fishing, construction work, shooting pool, playing guitar, gymnastics, and so much more.

WCBL patient, Larry French, demonstrates the uses of various upper extremity prosthetic devices custom designed and fabricated to restore his ability to enjoy a variety of recreational activities.

man with a prosthetic arm and a silicon hand

Hybrid

A hybrid upper extremity prosthetic device combines the use of body power and external power. The advantages of this system are a greater functional envelope from the basic body powered device; reduced weight from the myoelectric device; greater grip force similar to the myoelectric; the harness system is reduced; and the initial costs and maintenance costs are reduced.

Body Powered / Conventional

A body powered or conventional upper extremity prosthetic device is operated by a harness system. The harness system is controlled by specific body movements. The advantages of a conventional prosthesis are the heavy duty construction of the device increases durability; it offers proprioception; it’s less expensive and lighter in weight than myoelectric devices; and there is a reduced cost and maintenance. (NP, M-Fingers)