Understanding Upper Limb Prosthetic Options

Each person with upper limb loss presents a unique residual limb, with amputations that range from partial finger all the way to shoulder level, and some are missing multiple limbs. Equally diverse are the individual goals that patients have for their rehabilitation: returning to work, being independent, playing sports, caring for children and much more.

An Arm Dynamics initial prosthetic evaluation addresses all of these complexities and provides a detailed overview of the available prosthetic options.

Your client’s individual assessment will:

  • Explain the prosthetic, therapeutic and psychosocial aspects of care

  • Help them identify their functional goals

  • Examine the six prosthetic options

  • Determine which types of prostheses will allow them to reach their goals

  • Develop a timely rehabilitation plan

  • Provide an accurate cost estimate that prevents cost over-runs

Scott Spring, CPL discusses several prosthetic options to help Houston patient Xavier Collier achieve his goals

Six options when considering upper limb prosthetic care

Determining the most appropriate option begins with helping the patient set specific goals for using a prosthesis. Beyond meeting the most basic needs of self-care, dressing, cooking and eating, what tasks or activities do they want to use a prosthesis for? We look at work-related tasks, household chores, yard care, family activities, recreation, specific hobbies and skills.

In some cases, more than one prosthetic device may be necessary. For example, a person might need one type of prosthesis for a wet or dirty work environment, and another prosthesis that’s more appropriate for social or professional settings. Someone who’s passionate about fitness may need a specific prosthesis to use for exercise and another device for their daily activities.

Other key points we address include the overall weight of the prosthesis, how the device looks and feels, and ensuring that the socket interface allows for long-term, comfortable wear.

Option 1:

No Prosthesis

Some amputees, particularly those with partial finger and partial hand loss, may choose to adapt to living without the assistance of a prosthesis. One benefit is that the remaining portion of the upper limb is able to receive and interpret sensory feedback like temperature, texture and weight. There are also risks associated with this choice, including body alignment problems and overuse of the sound arm and hand. Patients who choose not to wear a prosthesis need to consult with an upper limb prosthetic specialist to discuss these risks.

Option 2:

Passive Prosthesis

While passive devices don’t offer active movement, they do improve function by providing a surface for bracing and carrying items. Some designs include locking joints to allow for positioning the arm or bending the fingers to hold an object. Passive prostheses are often made from silicone for a natural, lifelike appearance, and can also be created from lightweight metals and plastics that offer a high-tech look.

Option 3:

Body-Powered Prostheses

The durability and reliability of body-powered devices make them an efficient, cost-effective option for certain types of manual labor or hobbies. While they are appropriate for situations involving water, heat, dirt, grease, and sharp or heavy objects, they may not be the best option for everyone. Transradial and transhumeral amputees activate the prosthesis with exaggerated movements of the back, shoulders and neck, which can cause pain and lead to repetitive motion injuries.

"It’s amazing to see successful patient outcomes, like when people go back to work or are able to take care of their family again, or just getting to be independent and happy.”
Lauren Danahy
Lauren Danahy, RN, BS, MBA, CCM, LNCC, CCHP

Willamette Nurse Consultant Group LLC-Oregon

Option 4:

Electrically-Powered Prostheses

Myoelectric prostheses can expand a person’s range of motion, increase grip force of the electric hand or hook, and provide easier, more natural movement than body-powered devices. This option is available for all levels of upper limb loss and is particularly beneficial for amputations above the elbow. Electrically powered prostheses may be too heavy for some patients, and are not appropriate for use in wet or dirty environments.

Option 5:

Hybrid Prostheses

These devices combine body-powered and myoelectric components in one prosthesis to improve a person’s functional ability. These designs are usually for transhumeral, shoulder-level or forequarter amputees, and most commonly include a body-powered elbow and myoelectric hand that can be operated simultaneously. There are also hybrid designs for partial hand amputees that combine elements of two or more prosthetic options. Hybrid prostheses that include myoelectric components are not appropriate for use in wet or dirty environments.

Option 6:

Activity-Specific Prostheses

These highly specialized prostheses are designed for use in activities where other prosthetic options won’t work – riding a bike, playing an instrument, going fishing and much more. Often, people need one type of prosthesis to use at work and at home, and an activity-specific device to use for fitness training, playing sports or enjoying other hobbies. An activity-specific prostheses can reduce your client’s long-term healthcare costs by restoring their ability to be active, healthy and physically fit.

Phased care may also be an option

When a patient requires more than one type of prosthesis to maximize their rehabilitation potential, we team up with the insurance provider to develop a long-term plan for phased care. We often recommend starting with one device, while working towards optimal prosthetic solutions that will meet all of your client’s functional needs over time.

Together, we can redefine what’s possible for your clients with upper limb loss.