upper limb prosthesis

1. UPPER LIMB PROSTHESIS
Presented by:
Group 4

2. INTRODUCTION
Upper limb prosthesis designed to replace, as much as possible, the
function or appearance of a missing limb or body part.
Prosthesis can replace some grasping and manipulating functions of hand .
No sensory feedback.
A SUCCESSFUL PROSTHESIS:
Comfortable to wear
Easy to don and doff
Light weight and durable
Cosmetically pleasing
Reasonable maintenance

3. REASONS FOR AMPUTATION
• 1. infection
• 2. trauma
• 3. tumor
• 4. congenital deformity
• 5. 0 to 15 yrs: correction of congenitl deformity /tumor.
• 6. 15 to 45 yrs: trauma, tumor
• 7. 60 years: rare, tumor or medical disease.

4. LEVELS OF AMPUTATION
• 1. INTERPHALANGEAL AMPUTATION
• 2. TRANSMETACARPAL AMPUTATION
• 3. TRANSCARPAL AMPUTATION
• 4. WRIST DISARTICULATION
• 5.TRANSRADIAL AMPUTATION
• 6. ELBOW DISARTICULATION
• 7. TRANSHUMERAL AMPUTATION
• 8. SHOULDER DISARTICULATION
• 9. INTERSCAPULOTHORACIC DISARTICULATION

6. TYPES OF PROSTHESIS
• 1. BODY POWERED/ CONVENTIONAL
• 2. EXTERNAL POWERED/ ELECTRICAL
• 3. COSMETIC/ PASSIVE
• 4. HYBRID

7. BODY POWERED/CABLE CONTROLLED
• An arm prosthesis powered by movement in the upper extremity
portion of the body, specifically the muscles of shoulder, neck and back.
The motion of these movements is then captured by the harness system
that generates tension in the cable, allowing a terminal
device(hook/prosthetic hand) to open and close.

8. EXTERNALLY POWERED
PROSTHESIS/ELECTRICALLY POWERED
Prosthesis powered by electric motors may provide more proximal function
and greater grip strength, along with improved cosmesis but they can be
heavy and expensive. Patient controlled batteries and motors are used to
operate these prostheses. It requires a control system. It is of two types
myoelectric and switch control.

9. COMPONENTS OF UL PROSTHESIS
1. TERMINAL DEVICES
2. WRISTS
3. ELBOWS
4. SHOULDERS
5. SOCKET
6. SUSPENSION

10. TERMINAL DEVICES
1. PASSIVE TERMINAL DEVICE
Falls into two classes those designed primarily for function and those to
provide cosmesis. Examples include child mitt frequently used on infants first
prosthesis to facilitate crawling or ball handling used for ball sports. Its
cosmetic appearance is very good. Cosmetic passive devices are more
expensive then active terminal devices.
2. ACTIVE TERMINAL DEVICE
More functional than cosmetic. Two main categories
2. Hook
3. prosthetic hand
These are available to operate with cable or externally powered.

11. Prehensile/ non prehensile terminal devices
Non prehensile
Touching, feeling, pressing down with fingers, tapping vibrating the cord ,
lifting or pushing with hand.
Prehensile
The major function of the hand that the prosthesis tries to replicate is grip
(prehension).
The five types of grip are as follows
1. Precision grip
2. Tripod grip
3. Lateral grip
4. Hook power grip
5. Spherical grip

16. Components of Upper Limb
Prosthetics

17. Components of Upper Limb Prosthetics
• Following are the components of upper limb
prosthesis:
• Terminal device
• Cosmetic gloves
• Prosthetic wrists
• Prosthetic elbows
• Prosthetic sockets
• Suspension systems
(already discussed)

18. Cosmetic Gloves
• Used for digit and hand
• It is extended till elbow
• It is a custom made silicone cosmetic covers
• Expensive, and difficult to maintain.

19. Prosthetic Wrists
• Provide receptacle for connecting terminal
device
• Prono-supination or flexion based on
functional activities of patient
• Types of Prosthetic Wrists:
• The types are;
1. Mechanical
2. Electrical

20. Prosthetic Wrists (Cont.)
1. Mechanical Prosthetic Wrist:
• For prono-supination:
• Friction (helps in rotation)
• Quick disconnect
• Spring assisted (B/L amputee)
• For Flexion:
• Spring assisted internal or external
2. Electrical Prosthetic Wrist:
• For prono-supination:
• Myoelectric (B/L amputee)
• Switch control
Round and oval
configuration of
constant friction
wrist units

21. Prosthetic Wrists (Cont.)
Quick change wrist units Flexion wrist units Electrical wrist unit
(Ottobock wrist rotator)

22. Prosthetic Elbows
Prosthetic
Elbows
Body powered elbow
External with or
without spring assisted
(elbow disarticulation)
Internal, with or
without spring assisted
flexion
Internal, with rotating turntable
(allows internal / external rotation)
Externally powered
elbow
Switch control
Digital Proportional
Myoelectric control
Digital Proportional
Passive elbow
Manual lock

23. Prosthetic Elbows (Cont.)
Flexible hinges
Rigid hinges
Polycentric hinges
Step up hinges
Outside locking
Inside locking

24. Prosthetic Elbows (Cont.)
• Electrical Powered Elbow:
• These elbows differ from one another in
mechanical configuration, drive mechanism
and control options.
• Boston elbow
• NY-Hosmer Electric Elbow
• Utah Arm

25. Prosthetic Sockets
• Functions:
• Comfortable residual limb – prosthesis interface
• Efficient energy transference to the prosthesis
• Secure suspension of the prosthesis
• Adequate cosmesis
• Types of Prosthetic Sockets:
• Wrist disarticulation socket
• Long below elbow (trans radial) socket
• Short below elbow socket
• Very short below elbow socket
• Muenster sockets
• Elbow disarticulation socket
• Standard above elbow socket
• Short above elbow socket
• Shoulder disarticulation socket
• Forequarter amputation socket

26. Suspension Systems
• Functions:
• Suspension – securing prosthesis to
residual limb
• Control of prosthesis / terminal devices
• Types of Suspension Systems:
1. Harness:
Figure of 8 (traditional)
Chest strap (proximal amputation)
Shoulder saddle (proximal amputation)
Harness

27. Suspension System (Cont.)
2. Self suspension:
Condylar
Munster (self suspending; not preferred in B/L transradial amputation)
Northwestern
3. Semi-suction:
Hypobaric semi-suction
4. Suction:
Full suction
Silicone sock
5. Sock:
Interface b/w residual limb and socket.
Layers adjustable to volume changes
Protect skin and improve hygiene
Sock with special silicone band and socket with one way valve are used in semi-suction type of suspension system
Suction suspension preferred for transhumeral amputee
with normal contralateral limb

28. Control Mechanisms
• Body Powered (Harness)
Scapular abduction
Chest expansion
Shoulder depression, extension, abduction,
flexion
Elbow flexion, extension
• Discomfort
• Less cosmetic

29. Control Mechanisms (Cont.)
Mechanics of Trans Radial Control System Glenohumeral joint flexion for
operating a terminal device

30. Control Mechanisms (Cont.)
Heavy-Duty Trans Radial Harness Bilateral Trans Radial Harness

31. Control Mechanisms (Cont.)
Trans Humeral Control System
Two types of control cable:
1. Elbow – flexion/terminal device control
cable
2. Elbow lock – control cable
Trans Humeral Harness Control

32. The Operating Sequence of the Two Cable
Systems
• Tension applied to the elbow
flexion/terminal device control cable
causes the elbow to flex.
• When the desired angle of elbow
flexion is achieved, the rapid
sequential application and release of
tension on the elbow lock control
cable locks the elbow
• With the elbow locked, the
reapplication of tension on the elbow
flexion/terminal device control cable
permits operation of the terminal
device.
Shoulder Disarticulation Harness

33. Prostheses by level of
amputation

34. Prosthesis by level of amputation
Partial Hand:
• Prosthesis not necessary
• Surgical reconstruction – opposition – for
prehension with proprioception

35. Prosthesis by level of amputation (Cont.)
Wrist Disarticulation:
• Distal radial-ulnar articulation preserved for
prono-supination
• Socket: tapered and flattened distally forming
an oval shape
• Wrist unit: thin, to minimize length.
• Cosmetically: trans-radial

36. Prosthesis by level of amputation (Cont.)
Trans Radial Amputation (Below Elbow):
• Classification (based on length)
1. Very short (<35%): rigid elbow hinges
2. Short (35-55%): <60 degrees prono-supination, flexible elbow hinges
3. Long (55-90%): 60-120 degrees prono-supination, flexible elbow hinges
Below elbow prosthesis

37. Prosthesis by level of amputation (Cont.)
Trans Radial Amputation With Decreased
Elbow ROM:
• Polycentric elbow joints or split socket with
step-up hinges used to provide additional
flexion
• Decreased elbow flexion power

38. Prosthesis by level of amputation (Cont.)
Elbow Disarticulation:
• Sockets: Flat and broad distally (like epicondyles)
• External elbow joint with cable operated lock in
medial joint
• Suspension: figure of 8, shoulder saddle, chest
strap
• Control System: two cables; one to lock the elbow,
other opens terminal device or flexes elbow

39. Prosthesis by level of amputation (Cont.)
Trans Humeral Amputation (Above Elbow):
Classification: (based on the length of humerus)
1. Very short (<30%)
2. Short (30-50%)
3. Standard (50-90%)

40. Prosthesis by level of amputation (Cont.)
Socket Design of Trans Humeral Prosthesis:
Trans Humeral
Socket
Residual limb
greater than 35%
Proximal trimline
within 1cm of
acromion,
Suspension with
figure of 8, shoulder
saddle or chest strap
Residual limb
smaller than 35%
Proximal trimline
2.5cm medial to
acromion
Suspension with
chest strap or
suction socket

41. Prosthesis by level of amputation (Cont.)
Elbow Joints for Trans Humeral Prosthesis:
Elbow Joints
Internal Elbow
Joint
Preferred
Level of amputation 4cm or
more proximal from
epicondyles
Allow passive internal /
external rotation
Elbow spring lift assist
available
External Elbow
Joint
Distal
amputation
Maintain elbow
center with
contralateral side

42. Prosthesis by level of amputation (Cont.)
Control System for Trans Humeral Prosthesis:
• Dual cable (like elbow disarticulation)
Above elbow prosthesis

43. Prosthesis by level of amputation (Cont.)
• The prosthesis for this type of
amputation is fabricated as;
1. Socket:
 Extends to thorax
 Open-frame socket to decrease
weight and heat
 Similar to trans humeral (above
elbow) + shoulder unit
Shoulder Disarticulation and Forequarter
Amputation:
Bulk head
(Flexion/extension)
Universal

44. Prosthesis by level of amputation (Cont.)
2. Control:
 Triple cable system:
 One for elbow flexion when opposite humerus is flexed
 Second cable opens terminal device with chest expansion
 Third cable locks / unlocks elbow with chin / opposite hand
Externally powered prosthesis is generally preferred
Passive cosmetic prosthetic restoration in some patients
Shoulder Disarticulation and Forequarter
Amputation: