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What is a prosthetic arm?

A prosthetic arm, or upper limb prosthesis, is an artificial replacement for your natural arm. It can replace part or all of your upper limb, from your hand, wrist and forearm to your elbow, upper arm and shoulder. Prosthetic arms can be passive, like a mannequin arm, or high-tech, like a robotic arm.

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Who is a prosthetic arm for?

You might be interested in an upper limb prosthesis if you've had an arm amputation or you were born with a congenital limb difference that affects its appearance and/or functionality. Different types of prostheses are available for different types of upper limb amputations and limb differences, including:

• Transradial amputation. Amputation through your forearm bones.
• Elbow disarticulation. Amputation at your elbow joint.
• Transhumeral amputation. Amputation above the elbow and through your humerus.
• Shoulder disarticulation. Amputation at your glenohumeral (shoulder) joint.
• Forequarter amputation. Removal of your whole arm, shoulder blade and collarbone.
• Congenital limb deficiency. Underdeveloped arm bones, affecting the length and/or width of your arm.
• Ulnar clubhand. Undeveloped or underdeveloped ulna bone, causing your arm to bend inward.

What is the purpose of a prosthetic arm?

Different types of prosthetic arms serve different purposes. Some are more cosmetic, while others are more functional. Some are designed for everyday tasks, and others are designed for specific activities. If you have an absent arm or arm asymmetry, you might have use for several types of prosthetic arms.

What are the different types of prosthetic arms?

Different types of prosthetic arms replace different parts of your limb as needed. You might need a prosthesis with a shoulder joint, elbow joint and/or wrist joint and a prosthetic hand or other terminal device. Different types also have different purposes and ways of functioning. These types include:

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Passive arm prosthesis

A passive arm prosthesis doesn't function like a human arm, but it can look like one. You can get a custom, lifelike silicone arm (called a silicone restoration) that's modeled and painted to look just like a natural arm. You can usually position it a few different ways. It's a popular option for social functions.

Body-powered arm prosthesis

A body-powered arm prosthesis is a mechanical device that operates using a type of pulley system. Cables connect the device to muscles elsewhere on your body, such as your shoulder. You activate these muscles to make the device move. Typically, it has a tool or a claw at the end that can open and close.

Body-powered prostheses are a good option for repetitive tasks and hard manual labor. They're hardy and weatherproof and don't need a lot of calibrating to work. The cable and harness system provides sensory feedback when you use it, so you don't have to watch your prosthesis to know that it's working.

Activity-specific prosthetic arm

If you need a prosthesis to perform a specific job, sport or hobby, you can get one specifically designed for that purpose. A prosthetist will work with you to design a prosthesis that functions exactly as you need it to. They can customize what's on the end of it, how it moves and how much weight it can bear.

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Activity-specific prosthetic arms can allow you to work with specialized tools, operate machines or work out. They're easy to swap, and you might use different ones for different activities throughout the day. For example, you might use one type at work and another type at home or while pursuing a hobby.

Myoelectric arm prosthesis

A myoelectric arm prosthesis is an electronic device that operates through electrical impulses generated by your muscles. (Myo- means muscle.) You learn how to squeeze your muscles to trigger the device. Electrodes on your skin read your muscle contractions and signal to the device to make the joints move.

This electrical process uses less force than a body-powered prosthesis, so it's less stressful on your muscles over time. It can also allow for much more fine-tuned movements. Myoelectric arms have articulating joints, and they typically end in a bionic hand with individually articulating fingers.

This type of prosthesis can enable you to perform a wide variety of everyday tasks. But it's not always the most practical option for every task. It takes time to calibrate the device to perform the movements you want and skill to initiate complex movements. It's not ideal for physically stressful work conditions.

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Still, a myoelectric arm is a versatile option that can serve both practical and aesthetic purposes. It can look lifelike with a custom silicone overlay, or you can rock a futuristic, robotic look. Those who've mastered their bionic arm have relearned how to drive, type on a computer and play the piano with it. 

Hybrid prosthetic arm

Hybrid prosthetics combine myoelectric functions with body-powered ones. For example, a hybrid arm might combine a body-powered elbow joint with a myoelectric hand. This gives you the fine grip control of an articulating hand when you need it, along with the quicker and easier action of the arm when you don't.

What are the steps involved in getting a prosthetic arm?

Acquiring your own upper limb prosthesis and learning to use it is a huge undertaking. It will take time, practice and patience on your part. And you can expect to get to know your healthcare team really well.

Here's a brief breakdown of the steps involved:

• Consultation and assessment. The process begins with an assessment and consultation with your healthcare provider. They'll assess your physical fitness to use a prosthesis, then discuss your lifestyle, needs and goals to determine which type or types of prosthesis will serve you best.
• Fitting. Generally, fitting will take place three to six weeks after amputation surgery. During this process, your prosthetist will determine which muscle groups you'll use to operate your prosthesis and take careful measurements of your residual limb. They might make a mold or a 3D scan.
• Basic training. When your prosthesis is ready for you, your prosthetist will show you the basics of how it works and how to take care of it. You'll learn how to put it on and take it off, how to clean it, how to adjust it, and how to operate the different mechanical and electronic parts.
• Physical and occupational training. Next, you'll work with a physical therapist and/or occupational therapist to learn how to use your prosthesis in your daily life. You'll strengthen the necessary muscles and drill the necessary movement patterns to accomplish your tasks.
• Mental health care. While you're working hard to rehabilitate your body, you're also processing a major psychological event. Don't underestimate this part. Mental health professionals and peer support groups can help support this part of your journey, along with the physical part.

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Advantages and disadvantages

Osseointegration

Advantages

An osseointegrated prosthesis offers many advantages to individuals with an arm or leg amputation compared with a socket prosthesis (which fits over the stump of the amputated leg or arm). The attachment of the osseointegrated prosthesis is much more stable and provides a full range of joint movement, making walking much easier. An osseointegrated prosthesis does not cause pain or skin breakdown when used. Because the prosthesis is directly attached to the bone, the wearer feels as though their prosthesis is part of their own body by a process known as 'natural osseoperception' (i.e. it feels as though it is their own leg or arm). Since , the Radboud University Medical Centre (Radboudumc) in Nijmegen, the Netherlands, has been offering this highly innovative technique which significantly improves the quality of life of individuals with an amputation.

In , the Radboudumc carried out a study of the first 22 patients to be given an osseointegrated prosthesis at their centre. Aspects of walking and quality of life with the osseointegrated prosthesis were compared with a socket prosthesis. It was found that prosthesis use increased from 56 to 101 hours per week, walking speed increased by 32% and walking required 18% less energy with the osseointegrated prosthesis. Prosthesis-related quality of life improved from 39 to 62 on a scale of 0 to 100.

Advantages of an osseointegrated prosthesis

• Increased prosthetic use
• Longer walking distances
• Full range of joint movement
• Better sitting comfort
• No skin problems
• Stable and safer standing and sitting
• A sense of the artificial limb belonging to the body
• Easy and quick attachment and removal
• Improved quality of life.

Disadvantages

Osseointegration is a safe treatment, and inflammation of the bone is rare. A disadvantage is that the area where the implant enters the skin (called the 'stoma') has to be cleaned twice daily with soap and water. This is comparable with brushing the teeth. In some cases, the skin around the stoma may become irritated. In the first year after implantation, intense muscle pain may be felt. This muscle pain disappears as soon as the stump muscles become fitter and stronger.
 

An osseointegrated prosthesis offers many advantages to individuals with an arm or leg amputation compared with a socket prosthesis (which fits over the stump of the amputated leg or arm). The attachment of the osseointegrated prosthesis is much more stable and provides a full range of joint movement, making walking much easier. An osseointegrated prosthesis does not cause pain or skin breakdown when used. Because the prosthesis is directly attached to the bone, the wearer feels as though their prosthesis is part of their own body by a process known as 'natural osseoperception' (i.e. it feels as though it is their own leg or arm). Since , the Radboud University Medical Centre (Radboudumc) in Nijmegen, the Netherlands, has been offering this highly innovative technique which significantly improves the quality of life of individuals with an amputation.In , the Radboudumc carried out a study of the first 22 patients to be given an osseointegrated prosthesis at their centre. Aspects of walking and quality of life with the osseointegrated prosthesis were compared with a socket prosthesis. It was found that prosthesis use increased from 56 to 101 hours per week, walking speed increased by 32% and walking required 18% less energy with the osseointegrated prosthesis. Prosthesis-related quality of life improved from 39 to 62 on a scale of 0 to 100.Osseointegration is a safe treatment, and inflammation of the bone is rare. A disadvantage is that the area where the implant enters the skin (called the 'stoma') has to be cleaned twice daily with soap and water. This is comparable with brushing the teeth. In some cases, the skin around the stoma may become irritated. In the first year after implantation, intense muscle pain may be felt. This muscle pain disappears as soon as the stump muscles become fitter and stronger.

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