Upper Limb Prosthetics

Notice 2/11/15:  

In order to update site contents and add the additional "Partial-Hand" and "Passive + Cosmetic" prostheses pages, I will have to re-do the entire site in with a different, more current site builder that will support the required edits and format changes.  The current site will remain as it is until the new one is completely finished and then it will be switched over.

If you have any questions in the meantime, please feel free to contact me at upperlimbprosthetics@live.com

Thank you!


What makes upper limb prosthetics so unique?



Despite all the exciting technology on TV lately, upper-limb prosthetics actually accounts for a small fraction of the field of prosthetics.   There are an average of 18,496 upper-extremity amputations every year, compared to 113,702 of the lower extremity.  Of those, only 1900 are above the wrist.1   Among upper-limb amputees, typically fewer than half wear prosthetic arms.  All told, lower-extremity patients outnumber upper-extremity patients 30:1.  This small population means that most prosthetists do not get much experience in upper-limb patient care. 

Fitting upper-limb prostheses is complicated and challenging.  So far, we have been unable to get anywhere close to duplicating the elegance of the human hand.  The best outcomes seem to be associated with people who see their prosthesis more as a tool that helps them do things they want to do, rather than as a replacement limb.  However, that means the needs of any particular patient are as diverse and numerous as there are uses for the human hand.  We all use our legs for walking.  Hands though?  That’s a bit trickier.  How many different kinds of jobs are there in the world?  How many different hobbies?

The practice of upper-limb prosthetics is much different than that for the lower limb.  There is often a lot of customizing, adjusting, tweaking, problem-solving, and trial and error.  Done right, it requires more time and can be frustrating.  Patients unhappy with the fit or function of their prosthesis will likely just not wear it.  They don’t “need” to after all; they have another hand.  However, a large percentage of patients end up with overuse injuries of their sound arm.2,3  And, of course, there are many things it is helpful to have 2 "hands" for.  People with bilateral amputations (both sides) who rely on their prosthetic arms exclusively would especially benefit from working with a practitioner with extensive experience.   It may also be that such practitioners are more familiar with and adept at dealing with insurance companies with regard to obtaining authorization and coverage for upper-limb prostheses.  In addition, the use of myoelectrics is extremely complicated and unique.  There are specialized computer programs, electrodes, microprocessors, and wires that must be connected correctly, programmed, and maintained.  Many practitioners unfamiliar with the technology may be reluctant to attempt it and rather go with what they know--the standard body-powered hook--, even though it may not be the best choice for that particular patient.

It is difficult to figure out who to go to for upper-limb prosthetic care.  Within the field, there are professional organizations for practitioners interested in that area, but that information is not readily available to prospective patients.

It is my hope that every person with an upper-extremity loss or absence would have the opportunity to talk to a knowledgeable and experienced practitioner about the options available to them.

I have created this site in an attempt to help that happen.


Summary of site contents


Sockets and Interfaces discusses the design of prosthetic sockets (the part that goes over the residual limb or serves as the 'interface' between the prosthesis and the body) and various methods of keeping them on.

Body Powered explains the design of conventional, cable-controlled prostheses, their parts, how they work and how they are controlled.

Externally Powered discusses what are usually known as “myoelectric” or “bionic” prostheses.  It explains their design, parts, how they work, a little myo theory, and how they are controlled.

Adaptive gives brief overview of adaptive prostheses used in sports and recreational activities.

Which type is best discusses some of the factors that are considered when deciding which type of prosthesis is best for each person.  It explains amputation levels and some of the challenges and benefits of each.  It also has a brief discussion of the reasons people choose a hook vs hand, or body-powered vs. externally-powered.

Fitting Process gives an overview of what you will encounter when you go to a prosthetist's office.  It lists some of the things you should discuss with him and the overall process of being fit with a prosthesis.

Practitioner Listings is a list of some of the people who are known to be leaders in the field of upper limb prosthetics.  It is not a comprehensive list; it is, in fact, quite short, because I am very conscious of the hubris of someone like me deciding who should be listed.  I stuck with the obvious practitioners:  those who have published papers, spoken at national prosthetic conferences, educated others, and established practices dedicated to upper-limb prostheses.  It also lists the practitioners that have "consulting services" to assist other, out-state-prosthetists, in giving the best care to their clients.

Other Resources has links to support and educational resources for people with an upper-limb difference.  Some are specific for upper limb, and a few are not.

Videos has links to videos of people using different types of prostheses.  Some are instructional videos on how to do something with the prosthesis, some share information about different prosthetic technologies, and some are people talking about their personal experience. 

Insurance and Billing gives an overview of how prostheses are billed and information on dealing with insurance companies for coverage.

Prosthetic Parity explains what prosthetic parity legislation is and has links so that you can get the most up-to-date information on federal and state parity laws.

In the News/R+D has links to news stories about new and developing technologies in upper-limb prosthetics. 

Terms and Abbreviations has a list of terms and abbreviations that you may encounter.  They are divided into 3 sections: Prosthetic terms, Anatomical/medical terms, and abbreviations.

Contact / About me explains how I came to make this site and includes my email if you have any questions, comments, or concerns.

 

Wherever possible, I have displayed the full URL to external links so that, if the link doesn't work, you can copy and paste the address into your web browser.  Some, however, were so long that they were too visually distracting and altered the formatting of the site.




1.   
Dillingham TR, Pezzin LE, MacKenzie EJ, et al. Limb deficiency and amputation- epidemiology and recent trends in the US. South Med J 2002;95:875–83.

2.  Gambrell, CR.  Overuse Syndrome and the Unilateral Upper Limb Amputee: Consequences and Prevention.  Journal of Prosthetics and Orthotics 2008; vol 20, 3, pp126-132

3.   Jones LE, Davidson JH.  Save that Arm: A study of problems in the remaining arm of unilateral upper limb amputees.  Prosthetics Orthotics International 1999; 23; 55-58

Handshake photo of iLimb hand by
Touch Bionics, Inc.

 

 


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