1. Advancement of UE Prosthetics
Alexia Adams & Eddie Smith
Alexia

2. Fast Facts ~ 10,000 new UE amputations in the US every year
Most common causes of UE amputations
(1) Trauma
(2) Cancer
(3) Vascular complications
75% of UE amputations in adults are due to trauma
MVA
Machinery accident
Gunshot wound
Electrical burns
Ratio of upper limb to lower limb amputation is 1:4
Only ½ of UE amputees receive prosthetic services
Alexia

3. History 218 - 210 BC Marcus Sergius 1508 Gotz von Berlichingen
First documented user of a prosthetic hand
Roman general who made an iron hand fashioned to hold his shield
1508 Gotz von Berlichingen
Invented hands that could be manipulated through springs & straps
Ambroise Pare
“Father of Prosthetics”
Creator of Le Petit Lorrain hand made of iron that operated by springs and catches
Alexia

4. History 1863 Civil War 1915 Germany 1922 D.W. Dorrance
Major advancements in prosthetics
Rubber hand was invented
1915 Germany
First power-generated hand
1922 D.W. Dorrance
Inventor of the Split Hook Hand
1943 Reinhold Reiter
Inventor of the first myoelectric hand
Alexia

5. So where are we today…? Alexia

6. UE Prosthetic Options Passive or Cosmetic Prosthesis
Conventional or Body-Powered Prosthesis
Electrically Powered and Myoelectric Prosthesis
Hybrid Prosthesis
Adaptive or Recreational Prosthesis
No Prosthesis
Alexia

7. Passive or Cosmetic Prosthesis
Users do not require precise hand control such as grasp, but is often used more for aesthetic appeal.
Alexia

8. Passive or Cosmetic Prosthesis
Cost: ~$5,000
Advantages
Appearance
Lightweight
Simple and easy to use
Durable and easy to maintain
Provides limited function such as opposition and dexterity
Disadvantages
Limited function
High cost for custom fabrication
Unable to perform bimanual tasks
Possible insurance denial (unless medical necessity is justified)
Alexia

9. Conventional or Body-Powered Prosthesis
This prosthesis is often suspended from a harness fastened around the person's shoulder or upper torso.Movements utilize a cable connected to the harness at one end, and to a mechanical hand, hook or elbow at the other end for a wide range of basic function and control.
Alexia

10. Conventional or Body Powered Prosthesis
Cost: ~$10,000
Advantages
Lightweight
Less expensive
Durable and easy to maintain
Disadvantages
Appearance
Limited grip force
Harness can be uncomfortable and restrictive
Possible overuse injuries
Alexia

11. Electrically Powered and Myoelectric Prosthesis
Utilizes motors to open and close the hand, and can also flex and extend the elbow or rotate the wrist. User controls the prosthesis by contracting the muscles in the residual limb, generating EMG signals that activate the motor in the elbow, wrist or hand.
Could allow for greater range of motion, a more natural appearance, and enhanced work ability.
Alexia

12. Electrically Powered and Myoelectric Prosthesis
Cost: $20,000 - $100,000
Advantages
Appearance
Dexterity and function
Increased comfort and ROM
More energy efficient
Disadvantages
Cost
Weight
Battery maintenance
Difficult to maintain
Susceptible to harmful elements such as moisture and dust
Requires intensive training for successful outcome
Alexia

13. Hybrid Prosthesis
A hybrid (combination of elements of conventional and electrically powered prostheses) prosthesis provides the user with the unique ability to operate the elbow and the hand at the same time.
Used for transhumeral (above-elbow) amputees
The elbow joint is controlled via a harness system
The terminal device is controlled via an external power source
Eddie

14. Hybrid Prosthesis Advantages Disadvantages
Lighter weight than myoelectric prosthesis
Less harnessing than body-powered prosthesis
Greater grip force than body-powered prosthesis
Reduced initial and maintenance costs
Disadvantages
Control harness usually required
Increased weight on harness
Not suitable for all amputation levels
Eddie

15. Adaptive or Recreational Prosthesis
The activity-specific prosthesis is meant for the individual whose specialized requirements cannot be met by the other options. For example, custom adaptations can be fabricated for photography, swimming, basketball, baseball, hockey, golf, fishing, pool and most other recreational activities.
Eddie

16. Adaptive or Recreational Prosthesis
Advantages
Increased user function
Ability to resume previous work, hobbies, recreational activities
Disadvantages
Not covered by insurance
Eddie

17. No Prosthesis
Only 50% of UE amputees elect to be fitted with a prosthesis
Of that 50%, half abandon their prosthesis within a year
Eddie

18. No Prosthesis Cost: $0 Advantages Disadvantages No cost, maintenance
Easier to perform tasks with sound limb
Disadvantages
Psychosocial issues
Unable to perform bimanual tasks
Potential overuse injuries with sound limb
Eddie

19. So which prosthesis is best for your patient?
There is not a “right” or a “wrong” option. There are simply “better” and “worse” choices for each individual patient based on their specific needs.
The goal is to find a prosthetic option that will help your patient do what they want to do and live the life they want to live. Sometimes not using a prosthesis is the best choice.
In the end, the patient needs to choose which option is best for them because they will be the one wearing it. It does them no good if it sits in the closet collecting dust.
Keys to success: listen, educate, advocate, and find a good prosthetist who will do the same.
Eddie

20. The Future of UE Prosthetics
3D Printed Prosthetics
Enablingthefuture.org
Group who has created open source designs for mechanical hand assistive devices that can be downloaded and 3D printed for less than $50 in materials.
Targeted Muscle Reinnervation (TMR)
Surgical procedure that reassigns nerves that once controlled the arm and the hand.
Think about action they want to perform.
Osseointegration
Titanium fixture is surgically attached to the skeleton, then in a second procedure the prosthesis is attached to a skin penetrating abutment.
Eddie

21. The Future of UE Prosthetics, cont.
Eddie

22. References
Enabling The Future. Enabling The Future Available at: Accessed July 18, 2016.
Hand Prosthetics - History. Brown University Available at: Accessed July 12, 2016.
Historical Aspects of Powered Limb Prostheses. Digital Resource Foundation for the Orthotics and Prosthesis Community Available at Accessed July 11, 2016.
How Much Does a Prosthetic Arm Cost?. Cost Helper Health Available at: Accessed July 14, 2016.
Jonsson S, Caine-Winterberger K, Branemark R. Osseointegration amputation prostheses on the upper limbs: methods, prosthetics and rehabilitation. Prosthetics and Orthotics International. 2011;35(2): doi: /
Perry E. Targeted Muscle Reinnervation | Johns Hopkins Hospital in Baltimore, MD. Hopkinsmedicineorg Available at: Accessed July 18, 2016.
Prosthetic History: The Body-Powered Arm and William Selpho. The Open Prosthetics Project Available at: Accessed July 12, 2016.
Prosthetic Options - Hanger Clinic. Hangerclinic Available at: extremity/Pages/Prosthetic-Options.aspx. Accessed July 13, 2016.
Statistics on Hand and Arm Loss. Industry Safety & Hygiene News Available at: hand-and-arm-loss. Accessed July 11, 2016.
Upper Extremity Prosthetics. Westcoast Brace & Limb Available at: prosthetic-services/. Accessed July 14, 2016.
Upper Extremity Prosthetic Options. 360 Orthotics and Prosthetics Available at: upper-extremity-prosthetic-options.aspx. Accessed July 14, 2016.
Which Type of Prosthesis is Best? Upper Limb Prosthetics Information Available at: Accessed July 15, 2016.
Eddie

23. Questions???
Eddie