Upper Extremity Care

We know that loss of an upper limb may be one of the most difficult challenges you can face.

Approximately 40,000 Americans lose a limb annually, with approximately 30% of those losing a hand or arm.

Upper Extremity amputations are very complex, and each individual will typically require his or her own specialized solution. We are specialists in upper extremity prosthetics and provide comprehensive care for all levels of amputation, including bilateral (both sides) involvement.

With a customized care plan, P&O Care practitioners will work with you, your doctor and your rehabilitation team to develop a solution to improve your quality of life.

Levels of Upper Extremity Amputation

line-drawing of skeleton showing shoulder disarticulation

Forequarter/Intrascapular Thoracic & Shoulder Disarticulation

An interscapular-thoracic amputation is the surgical separation of the humerus (upper arm bone), scapula (shoulder blade), and a portion of the clavicle (collar bone) from the body in which the entire shoulder is removed.

A shoulder disarticulation is the removal of the entire arm from the shoulder joint. In this surgery the humerus (upper arm bone) and the entire arm are removed from the joint, keeping the scapula (shoulder blade) and clavicle (collar bone) intact.

A prosthetic solution for this level would consist of a customized socket (that would support and be harnessed to the trunk of the body), a prosthetic shoulder joint (if needed), an upper arm component, a prosthetic elbow joint, a lower arm component with a wrist joint and a terminal component (hand or hook).

line-drawing of skeleton showing transhumeral amputation

Transhumeral & Elbow Disarticulation

A transhumeral amputation (also called “above the elbow” or “AE”) includes the removal of the elbow joint and a portion of the upper arm bone (the humerus). An elbow disarticulation is only the removal of the arm at the elbow joint, keeping the humerus intact.

Your prosthesis options include a custom socket (to contain your residual limb), a prosthetic elbow joint, a lower arm component with a wrist joint and a terminal component (hand or hook).

body harness for use with upper prosthetic
line-drawing of skeleton showing transradial amputation

Transradial & Wrist Disarticulation

A transradial amputation (also called “below the elbow” or “BE”) includes amputations that occur through the two bones of your lower arm (radius and ulna). A wrist disarticulation (or “transcarpal amputation”) is the removal of the hand at the wrist, with parts of the radius and metacarpal bones being amputated.

A prosthesis options includes a custom socket (to contain your residual limb), a lower arm component and a wrist joint with a terminal component (hand or hook).

line-drawing of skeleton showing metacarpal amputation

Metacarpal / Partial Hand

There are many levels of amputation within the hand, ranging from a single digit/finger to the metacarpal bones.

Custom prosthetic solutions are available to provide you in order to maximize the use of your hand(s).

From partial finger prosthetics to a fully functional bionic hand, the P&O Care team will work with you to design a solution that meets your needs.

Solution Options

Nearly all upper extremity prostheses have two things in common:

  1. A custom-made socket (the intimately fitting frame around residual limb)
  2. A terminal component (a hand, hook or special use device).

Your lifestyle, goals and amputation level help to determine the prosthesis best suited for your needs and your P&O Care prosthetist will fully cover all of your options.

Bilateral upper extremity fittings can be quite complex, and require an extensive, experienced and accessible team. P&O Care prosthetists are equipped to handle the most complex cases and allow patients to return to independent living.

Types of Prosthetics:

A passive or “cosmetic” prosthetic is used for aesthetic appearance, rather than functional purposes. Passive solutions can appear remarkably lifelike, matching the skin tone and contours of your natural limb; have no moving or mechanical components and are relatively lightweight.

cosmetic hand prosthetic

A body powered prosthetic is strapped around the torso and the hand component (which is typically a hook or simple hand) is opened and closed with a shrugging motion of the shoulder.

body powered upper extremity prosthetic

An external powered prosthetic (also called myo-electric, bio-electronic or ‘bionic’) uses muscle signals from the arm to generate movement. These myo-electric signals from the body are detected by two sensors on each side of the residual limb, corresponding to flexor and extensor muscles. To open and close the hand, you just contract or relax your muscles as if to flex or extend the wrist.

patient with myo-electric hand prosthetics
A hybrid-electric prosthetic is a combination of body powered and myo-electric solutions. This is most common in higher level (above the elbow) amputees and may include a body powered elbow paired with myo-electric hand.

Types of Terminal Components:

Sized to match your “sound side” hand, both body and externally powered hands restore both appearance and function. Many prosthetic hands are closed at rest and open with body movement (body power) or muscle contraction (external power), depending on the design of your prosthesis. Prosthetic “skins” are typically used over the hand to best match your skin tone.

BODY POWERED: a cable extending from the base of a body powered hand is connected to your harness. Specific body movements are performed, tension is placed on the cable which opens and closes the thumb in relation to the index finger. This “pinch” grip is able to pick up light objects. The remaining fingers can be prepositioned, but do not actively move.

EXTERNALLY POWERED: There are many types of externally powered solutions, from hands with a moving thumb to more complex microprocessor-controlled components with 5 individually moving fingers. Externally powered hands receive input from electrodes imbedded in the socket that pick up the muscle signals from the residual limb to open and close the hand. A chargeable battery within the prosthesis provides the “external power” to allow the hand to function. Microprocessor controlled hands are the most advanced upper extremity prosthetic components. An onboard microprocessor receives input from the electrodes and generates specific commands and hand grasping patterns, based on programming by the prosthetist, with up to 21 grasp and gesture patterns.

various hook prostheticsWhile they may look intimidating, hooks can be very useful tools for an upper extremity amputee.Extremely lightweight and cost effective, hooks are extremely durable and useful.

There are many different styles of hooks (both body powered or externally powered), made of different materials, shapes and sizes depending on your needs. Often, some patients like to wear a hook for their day-to-day activities but prefer to use a hand for more formal occasions or social events. A quick-change wrist is a special receiver on the end of an upper extremity socket that allows the user to quickly change from one terminal device to another, changing from a hook to hand in a matter of seconds.

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Contact us to schedule an appointment or speak with one of our clinicians.

Do you need a prosthesis? Do you have a prosthetic that needs adjusting? Properly designed prosthetic solutions can dramatically improve your quality of life.

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