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Section 2: Upper Limb
Figure 34
tional stability between the prosthetic socket and the residual forearm. B, A transradial prosthesis
with a single-axis hinge. (Courtesy of Jim Skardoutos, C-Fab)
Photographs of single-axis hinges. A, A single-axis hinge provides axial and rota-
Step-up Hinges
Shorter amputation levels, immediately
distal to the elbow joint, require a prosthetic socket with extremely high trim
lines to provide adequate stability. Consequently, flexion of the anatomic elbow
in the prosthesis is often restricted to
90° or less. If full range of elbow flexion
is essential, step-up hinges may be used
to overcome this limitation.
Step-up hinges require separation of
the prosthetic forearm and socket, creat
ing a split-socket prosthesis (Figure 36).
Step-up hinges amplify the excursion of
anatomic elbow joint motion by a ratio
of approximately 2 to 1, such that 60°
of anatomic elbow flexion causes the
prosthetic forearm (and the terminal device) to move through a range of approximately 120°. This mechanism requires
the user to exert twice as much force to
flex the forearm. There are two types
of step-up hinges: sliding action and
geared joints. The sliding action stepup hinges have a variable amount of
flexion amplification depending on the
position of the joint. At midrange, where
most use occurs, the amplification is the
greatest. Sliding action hinges require a
split-housing cable system. Geared stepup hinges may use a standard Bowden
cable system.
-
Residual Limb-Activated
Locking Hinges
Amputees with the shortest transradial
amputation levels often cannot operate
a conventional transradial prosthesis
Figure 35
transradial prosthesis (B). (Courtesy of Jim Skardoutos, C-Fab.)
A, Photographs of Hosmer polycentric hinges (A) and the hinges installed on a
because of inadequate strength, range
of motion, or load bearing on the surface of the residual limb. Residual limbactivated locking hinges (Figure 37)
when carrying heavy objects. This setting helps unweight the shorter residual
limb and prevents hyperextension.
Polycentric Hinges
Short transradial limbs require that
the anterior proximal trim line of the
prosthetic socket be positioned close to
the elbow joint for stability. The high
Atlas of Amputations and Limb Deciencies, Fourth Edition © 2016 American Academy of Orthopaedic Surgeons
152
anterior socket wall can restrict full elbow flexion resulting from the bunching
of soft tissues in the antecubital region.
Polycentric hinges reduce the tendency
for bunching of the soft tissues by providing more room in the cubital area as
the elbow is flexed, thereby increasing
the potential range of motion at this
joint (Figure 35).
address this issue by using movement
of the residual limb to operate the locking hinges.
The prosthesis is cabled and controlled as a transhumeral prosthesis,
and a split-socket design allows the
short residual limb to control the hinge
lock. When unlocked, glenohumeral
flexion causes forearm flexion through
a split-housing, dual-control cable system. The user locks the forearm in place
by flexing the residual limb and split
socket. Extension releases the lock and
allows free swing of the elbow or positioning by the cable system with shoulder flexion.
Units for Elbow
Disarticulation and
Transhumeral Prostheses
Absence of the anatomic elbow joint
requires a mechanical substitute that
permits control of flexion and extension through a range of at least 135°.
In addition, the unit must permit the
user to lock and unlock the elbow at
various points throughout the 135° arc.
Body-powered elbows require up to 5
cm of cable excursion for full operation.
Chapter 11: Upper Limb Body-Powered Components
Figure 36
split-socket transradial prosthesis (B). (Courtesy of Jim Skardoutos, C-Fab.)
Photographs of sliding-action step-up hinges (A) and the hinges installed on a
Outside-Locking Hinges
Outside-locking hinges are necessary
for elbow disarticulation and long transhumeral limbs that do not have sufficient space for a traditional elbow unit
(Figure 38). They are named for their
position on the outside of the humeral
condyles. The lock is usually installed
on the medial side and can be controlled
manually or by cable activation through
shoulder movement. Outside-locking
hinges are available from several manufacturers in standard, heavy-duty,
and low-profile models and in a range
of sizes.
Elbow Units
Whether or not an elbow unit can be
used depends on the available distance
or clearance between the end of the
residual limb and the place where the
anatomic elbow center should be located. Elbow joints vary in their proximal clearance height, but most are
approximately 1.5 to 2.0 inches (3.8 to
5.0 cm). The practitioner also must allow
for the thickness of any socket materials
or suspension mechanisms and for access to the hardware for the friction adjustment of humeral rotation. Therefore,
Figure 37
hinges installed on a split-socket, transradial prosthesis (B). (Courtesy of Jim Skardoutos, C-Fab.)
the guideline traditionally has been that
transhumeral amputations approximately 5 cm proximal to the elbow joint
permit the use of inside-locking elbow
units.
Photographs of locking hinges that are activated by the residual limb (A) and the
The ENER~JOINT (TRS; Figure 40)
is a passive, locking polyurethane
joint that is designed to absorb shock
during high-impact activities and dampen transmission of forces through the
prosthesis to permit a more stable grip
Friction Elbows
Friction elbows are lightweight and
simple to operate but require passive
during certain activities, such as mountain biking and operating a chainsaw or
jackhammer.
positioning of the forearm (Figure 39).
For this reason, they can be appropriate
for low-impact users, pediatric applications, cosmetic restorations, and in
instances when brachial plexus injury
or other factors preclude active elbow
function.
Inside-Locking Elbows
Inside-locking elbow units contain the
joint and locking mechanism inside an
outer shell and are installed distally to
the residual limb. The elbow locking
mechanism is usually triggered by a
© 2016 American Academy of Orthopaedic Surgeons Atlas of Amputations and Limb Deciencies, Fourth Edition
153
Section 2: Upper Limb
Figure 38
(Hosmer) for use on a prosthetic device after a long transhumeral amputation or an elbow disarticulation. B, The standard Hosmer Outside Locking Hinge is shown installed on a transhumeral
prosthesis. (Courtesy of Jim Skardoutos, C-Fab.)
Photographs of o utside-loc king hinges. A, The Heav y-Duty Ou tside Locking Hing e
cable or string that exits through the
anterior surface of the unit. The cable
is traditionally connected to an elastic
strap that runs over the top of the shoulder, and a small amount of excursion
generated by shoulder movement locks
and unlocks the joint. These elbows
vary in the number of locking positions
and range of flexion. As with all types
of manual joints, more locking positions permit more precise positioning
of the terminal device. In addition,
Figure 40
JOINT. This elbow joint is designed to absorb
shock during high-impact activities. (Courtesy
of TRS, Boulder, CO.)
Photograph of the ENER~
all inside-locking units incorporate a
proximal friction-held turntable that
permits manual pre-positioning of the
pros thetic forearm to substitute for the
loss of active external and internal humeral rotation.
The E-series elbows by Hosmer are
available in three sizes and a heavyduty version (Fi g u r e 41). The Automatic Elbow (RSL Steeper) is similar
but also has the unique ability to lock
in humeral rotation in 30° increments
(Figure 42, A). The lock on the adult
Manual Elbow (RSL Steeper) is controlled manually with a sliding knob
on its integrated forearm (Figure 42, B).
Ottobock also offers several elbow units
with varying features and integrated,
prefabricated forearm shells that can
simplify fabrication and reduce system
weight.
In contrast to the fixed-locking positions of most elbow units, the ErgoArm
(Ottobock; Figure 43) features a unique
mechanism that allows locking and
release in any position throughout its
range of motion. It uses the same alternating locking-unlocking activation
pattern, but the friction clutch design
has an additional slip-stop function that
lowers the elbow without completely
unlocking the joint. Pulling the control
cable 3 to 4 mm fully locks or unlocks
the elbow. Pulling the cable 1 mm slips
the clutch so that gravity gently lowers
the forearm. When the forearm reaches the desired position, the user simply
Figure 39
Elbow joint. (Courtesy of RSL Steeper, Leeds,
England).
Figure 41
bow, an inside locking elbow unit. (Courtesy of
Hosmer, Chattanooga, TN.)
Photograph of the Friction
Photograph of the E-400 El-
relaxes the cable tension, and the elbow
immediately locks in that position. If
overloaded, the elbow will simply release instead of breaking.
The ErgoArm is available with or
without a unique lift assist mechanism called Automatic Forearm Balance (Ottobock). In the ErgoArm Plus
(Ottobock), the automatic forearm
balance mechanism is a spring-loaded
cam mechanism mounted within the
forearm that can be adjusted to completely counterbalance the weight of the
forearm-wrist terminal device assembly
during elbow flexion. This feature can
supplement the lifting power provided
Atlas of Amputations and Limb Deciencies, Fourth Edition © 2016 American Academy of Orthopaedic Surgeons
154
Chapter 11: Upper Limb Body-Powered Components
Figure 42
shell, and lamination ring. B, The Manual Elbow in an adult size. This elbow locks with a knob on
the forearm. (Courtesy of RSL Steeper, Leeds, England.)
Figure 44
exion assistance mechanism installed on the
medial side of a left transhumeral prosthesis.
Photographs of prosthetic elbows. A, The Automatic Elbow unit, optional forearm
Photograph show s the Hosmer
Figure 45
head. (Courtesy of Hosmer, Chattanooga, TN.)
Photograph of a shoulder bulk-
Figure 43
This device has a uni que mechanism that allows
locking and release in any position throughout
its range of motion, as well as Automatic Forearm Balance for assistance in lifting, and a low
clearance for l onger residual limbs. (Cour tesy of
Ottobock, Austin, TX.)
Photograph of the ErgoArm.
through a standard body-powered cable
or it can be adjusted to facilitate ballistic
flexion of the unit through gross body
movements. A finger wheel on the fore-
ErgoArm Electronic Plus (Ottobock)
adds electronic control of the elbow lock
inputs, such as the electromyographic
signal or switch.
arm allows the user to adjust the level
of assistance as desired.
The ErgoArm Hybrid Plus (Ottobock) features the same elbow mechanism and Automatic Forearm Balance
but has been configured for use with externally powered components. Although
elbow motion is still controlled with a
cable, internal electronics and integrated
wiring allow transmission of signals to
the wrist and the terminal device. The
Elbow Flexion Assists
Although the integrated automatic forearm balance on the ErgoArm Plus can
completely counterbalance the distal
weight of the components and provide
increased assistance in flexion, a springlift assist can be added to other mechanical elbows to partially counterbalance
the weight of the prosthetic forearm and
reduce the force necessary for elbow
Figure 46
duction hinge installed on a shoulder disar ticulation prosthesis. (Courtesy of Jim Skardoutos,
C-Fab.)
Photograph of a shoulder ab-
flexion. Such force reductions may permit subtle harnessing adjustments that
require less excursion. In addition, the
reduced strain on the limb may reduce
© 2016 American Academy of Orthopaedic Surgeons Atlas of Amputations and Limb Deciencies, Fourth Edition
155
Section 2: Upper Limb
Figure 47
installed on a shoulder disarticulation prosthesis (B). (Panel A courtesy of Hosmer, Chattanooga,
TN. Panel B courtesy of Jim Skardoutos, C-Fab.)
Photographs of a double-axis exion-abduction hinge (A) and the hinge shown
Figure 48
der Swing joint. (Courtesy of Ottobock, Austin,
TX.)
Photograph of th e MovoShoul-
Photograph of a preparatory
Figure 49
between two wrist units, such as friction wrists (B), which are screwed onto both threaded studs
of the hinge to provide humeral rotation and glenohumeral exion and extension. (Courtesy of
Hosmer, Chattanooga, TN.)
A, Photograph of the Universal Shoulder Joint. The abduction hinge joint is used
Figure 50
prosthesis wi th an installed SJ90 Loc king Shoulder Joint (Liberating Technologies, Holliston,
MA) and manual lever lock.
provide flexion and extension in the
sagittal plane (Figure 45). Single-axis
shoulder joints provide only abduction
shear forces between the socket and the
8
skin.
Although optional, elbow flexion
assistance components are prescribed
routinely, particularly for use with
heavier terminal devices (Figure 44).
Shoulders
Currently, all available shoulder joints
rely on passive and strategic pre-positioning to facilitate the optimal use of
other prosthetic components. Most use
Atlas of Amputations and Limb Deciencies, Fourth Edition © 2016 American Academy of Orthopaedic Surgeons
156
occurs with the humeral segment vertical and the elbow near 90°. Users of a
unilateral prosthesis may find minimal
shoulder movement acceptable and may
appreciate the weight savings from simplifying this joint.
Shoulder joints are generally classified according to the degree of motion allowed. The simplest design is
termed a bulkhead, which consists of
a circular unit integrated vertically to
(Figure 46), and double-axis units provide abduction and flexion. Double-axis
joints usually consist of a single-axis abduction hinge on top of a rotating plate
that provides the flexion and extension
(Figure 47). One double-axis shoulder
joint unlocks when abducted and locks
when adducted. The user swings his or
her arm to the side to unlock the joint,
then swings it forward and adducts it to
lock it in place (Figure 48).
Chapter 11: Upper Limb Body-Powered Components
Figure 51
unit. (Courtesy of Hosmer, Chattanooga, TN.)
Photograph of a nu dge control
The Universal Shoulder Joint (Hosmer) allows flexion in the sagittal plane,
abduction in the coronal plane, and rotation about the humeral axis (Figure 49).
It consists of a single-axis hinge with a
threaded stud and friction wrist unit on
both ends. One wrist unit is laminated
into the shoulder socket facing outward,
and the other attaches to the distal end
of the shoulder unit to form the top of
the humeral section. The hinge provides
abduction in the coronal plane. The top
wrist unit allows flexion and extension,
and the bottom wrist unit permits humeral rotation.
The Locking Shoulder Joint (Liberating Technologies) can stabilize a
shoulder in 36 different flexion positions (Figure 50). This feature benefits
individuals who wish to use the terminal device for upper quadrant activities
such as reaching items on a high shelf.
The lock can be operated manually or
by using an electrically powered switch.
A second, adjustable hinge with friction control and ratcheting mechanism
provides abduction and adduction
stabilization.
Figure 52
o-the-shelf socket and suspension system for body-powered, transradial prostheses. (Courtesy
of ToughWare Prosthetics, Westminster, CO.)
Figure 53
a self-suspending transradial socket. (Courtesy
of TRS, Boulder, CO.)
Photographs of the International Transradial Adjustable Limb. This device is an
Photograph of an e ndoskeletal
Photograph of an ELF Strap on
Figure 54
transhumeral prosthesis system. (Courtesy of
RSL Steeper, Leeds, England.)
and excursion required to operate the
locking mechanism of a shoulder joint
Other Socket Components
The nudge control unit is a paddle-shaped
lever that can be pushed by the chin or a
phocomelic digit or against environmental objects to provide a small amount of
cable excursion (Figure 51). It is usually
prescribed when other body motions
are not available. Although originally
designed to provide elbow locking and
unlocking, it also can be adapted to operate other components, including flexion and rotation wrist units. The power
may necessitate the modification of a
nudge switch with a lever extension.
The International Transradial Adjustable Limb (ToughWare Prosthetics) is an
off-the-shelf socket and suspension system for body-powered, transradial pros
theses (Figure 52). The ELF Strap (TRS;
Figure 53) is a rubberized extension designed to replace one of the functions
of the triceps cuff in self-suspending,
body-powered, transradial prostheses.
It attaches to the posterior of the socket
-
© 2016 American Academy of Orthopaedic Surgeons Atlas of Amputations and Limb Deciencies, Fourth Edition
157
Section 2: Upper Limb
to provide an anchor point and stable
routing for the control cable.
Endoskeletal Systems
Endoskeletal upper limb prosthetic
systems are composed of tubular humeral and forearm elements, and the
components allow for encasement in
cosmetic foam covers (Figure 54). After
final shaping and covering with a skincolored stockinette or nylon, the completed prosthesis affords a high degree
of cosmetic acceptability. In addition to
improved cosmesis and softness, modular prostheses are lighter in weight than
conventional artificial limbs. Three different endoskeletal upper limb prosthetic systems are currently available from
Ottobock, RSL Steeper, and Hosmer.
Endoskeletal systems vary in exact
components, connectors, mechanisms
of movement, and durability, but they
are usually passive and allow positioning with friction joints. Most allow
rotation of different segments, and many
use ball-and-socket joints. Any terminal
devices with the standard thread can
be used, although a cosmetic passive
hand is usually chosen. Elbows may
be passive or cable controlled, with or
without locking capability. Shoulders
are available in single-axis, double-axis,
or ball-and-socket configurations.
Summary
The main goal in providing a patient
with a prosthesis is to enable him or her
to use the device as much as is needed
to accomplish activities that are most
important to that individual. Prosthetic use and acceptance is considerably
increased when the user has an integral role in the selection process and
is allowed to provide feedback during
the fitting process. Acceptance or rejection may result from discomfort, a
lack of desired function, appearance,
or any number of reasons that the clinician may not anticipate. Therefore,
it is important to include the user in
any discussion about and selection of
component choices. No body-powered
or externally powered device can fully
replace the human hand. Each of the
components discussed in this chapter
has its best applications, misuses, pros,
and cons. Together, the clinician and
patient must engage in a thorough discussion about these factors and must
prioritize the patient’s desired functions
and ultimate goals.
References
1. Stark G: Upper limb prosthetic
competency and characteristics
among self-assessed novices-intermediates and experts-specialists.
J Assoc Pediatr Orthot Prosthet Clin
2014;20(1):11-13.
2. Fraser CM: An evaluation of the
use made of cosmetic and functional prostheses by unilateral upper
limb amputees. Prosthet Orthot Int
1998;22(3):216-223. Medline
3. Smit G, Bongers RM, Van der Sluis
CK, Plettenburg DH: Eciency
of voluntary opening hand and
hook prosthetic devices: 24 years
of development? J Rehabil Res Dev
2012;49(4):523-534. Medline DOI
4. Smit G, Plettenburg DH: Eciency of voluntary closing hand and
hook prostheses. Prosthet Orthot Int
2010;34(4):411-427. Medline DOI
5. Kestner S: Dening the relationship
between prosthetic wrist function
and its use in performing work tasks
and activities of daily living. J Pros-
thet Orthot 2006;18(3):80-86. DOI
6. Kyberd PJ: e inuence of passive
wrist joints on the functionality of
prosthetic hands. Prosthet Orthot Int
2012;36(1):33-38. Medline DOI
7. Bertels T, Schmalz T, Ludwigs E:
Objectifying the functional advantages of prosthetic wrist function.
J Prosthet Orthot 20 09;21(2):74-78.
DOI
8. Miguelez J, Conyers D, Lang M, Gulick K: Upper extremity prosthetics,
in Pasquina P, Cooper R, eds: Care of
the Combat Amputee. Washington,
DC, Borden Institute of Walter Reed
Army Medical Center and Oce
of the Surgeon General, 2009, pp
607-640.
Atlas of Amputations and Limb Deciencies, Fourth Edition © 2016 American Academy of Orthopaedic Surgeons
158
Chapter 12
Harnessing and Controls for Upper Limb
Body-Powered Prostheses
David B. Rotter, CPO
Abstract
Body-powered prosthetic devices are an eective method of controlling upper limb prostheses. Body-powered prostheses use body movements, which are captured with control straps
and cables, to generate volitional movement. For those with bilateral involvement, body
power is generally the preferred method of control because of the improved proprioception
and reliability oered.
Keywords: figure-of-8 harness; force and excursion; prosthesis;
transradial prosthesis
Introduction
Body-powered prostheses for the upper limb are controlled by harnessing
or capturing movements from segments
of the patient’s body that are intact and
capable of generating volitional movement. The movement from the intact
segment becomes a transferrable force
that actuates body-powered components, including elbows and terminal
devices. This is most often accomplished
by a transmission of movement through
a series of harness straps and cables
that start at a fixed point on the body
and create a reaction at targeted bodypowered components.
Despite exciting developments in
externally powered prosthetic options,
body-powered prosthetic devices continue to be relevant as a viable and effective means of controlling upper limb
prostheses. For many patients with bilateral involvement, body power is the
preferred method of control because of
the improved proprioception and reliability offered.
Mr. Rotter or an immediate family member serves as a board member, owner, ocer, or committee
member of the Association of Children’s Prosthetic and Orthotic Clinics.
2
1
Body-powered prostheses have stood
the test of time for a variety of reasons.
They involve relatively lightweight, durable components that create consistent,
dependable reactions every time they
are used. Because there is no need for
an external power source, the dependency on a source of electricity for recharging is eliminated. An important
and often overlooked advantage is the
sensory feedback provided to users of
body-powered devices. The users can
feel how much tension they are exerting
through the socket and harness and can
feel how much movement is taking place
at the terminal device. This one-to-one
relationship of movement to sensory
feedback allows the user to know where
his or her prosthesis is in space.
From the earliest concepts to current
practice, novel approaches of capturing
body movements to control upper limb
prostheses have been developed, refined, and subsequently taught to future
generations of prosthetists. This chapter reviews basic harnessing and body
3
power theory, discusses body-powered
options at each major level of upper limb
amputation, and describes the available
movements used to actuate body-powered components. Alternative harnessing strategies designed to address more
specific needs along with their clinical
relevance are also discussed.
Finger Prostheses
The past decade has seen the development of many body-powered choices for
patients with a partial hand amputation, with commercially available options for those missing single or multiple
fingers. Three body-powered systems,
the Biomechanical Prosthetic Finger
(Naked Prosthetics), the X-Finger (Didrick Medical), and the Partial M-Finger
(Liberating Technologies), use forward
flexion of the remnant finger to cause
the prosthetic finger to close. It should
be noted that no partial hand–specific
devices have strong force and excursion
options.
Biomechanical Prosthetic Finger
The Biomechanical Prosthetic Finger
(BPF) is intended for finger amputations
distal to the proximal interphalangeal
joint where sufficient length and flexion
mobility of the residual middle phalanx
remains. A proximal frame surrounds
the proximal phalanx with a second
frame surrounding the middle phalanx.
Flexion and extension between these
two frames are captured by a linkage
joint that transmits flexion force and
movement to a prosthetic distal interphalangeal joint, moving a prosthetic
distal phalanx.
© 2016 American Academy of Orthopaedic Surgeons Atlas of Amputations and Limb Deciencies, Fourth Edition
159
Section 2: Upper Limb
X-Fingers
The X-Finger system is intended for a
finger amputation distal to the metacarpophalangeal joint. It uses an anchor
point located at the base of the knuckle
that extends into the palm. As the user
flexes the remnant finger, a polycentric
linkage mechanism flexes the prosthetic
fingertip (Figure 1).
Partial M-Fingers
The Partial M-Finger is also intended
for finger amputation distal to the
metacarpophalangeal joint. The
M-Finger uses a cable system that is
mounted on the dorsal surface of the
hand. The mounting acts as the anchor, and metacarpophalangeal flexion
creates cable tension that causes the
partial finger element to flex volarly
(Figure 2). Internal springs extend the
interphalangeal joint in the absence of
cable tension.
Partial Hand Prostheses
M-Fingers
M-Fingers use the movement of wrist
flexion as the prime mover. As the user
flexes his or her wrist, cables, which are
anchored on a frame mounted proximal
to the dorsal aspect of the forearm, are
pulled. The frame acts as the anchor,
and the action of wrist flexion acts to
close the fingers about an object. The
available force and excursion are both
limited, making this type of prosthesis
better suited for lighter duty applications
(Figure 3).
Figure 1
without its cosmetic cover. Flexion at the metacarpal-phalangeal joint of the residual digit
produces exion at the interphalangeal joints
of the prosthesis. (Courtesy of Didrick Medical,
Naples, Florida.)
Photograph of the X-Finger
Figure 2
M-Finger. In a device anchored at the wrist of
the aected limb, metacarpophalangeal exion creates the cable excursion needed to create interphalangeal exion in the prosthesis.
(Courtesy of Lib erating Technologies, Hol liston,
MA.)
Photograph of the Partial
Minnesota Split-Hand Prosthesis
The Minnesota split-hand device is
an example of a prosthesis that uses
wrist flexion and extension to activate
a hinged, split hand. The hand is split
at its base, making the thumb a stationary component while the top section of
the hand is activated with wrist flexion. Force and excursion are moderate
to good with this type of device. It is
appropriate for use in an individual
with a congenital limb deficiency at the
Atlas of Amputations and Limb Deciencies, Fourth Edition © 2016 American Academy of Orthopaedic Surgeons
160
Figure 3
neutral or slightly extended position. B, Wrist exion causes the cable to become taught, closing
the ngers. (Courtesy of Liberating Technologies, Holliston, MA.)
Photographs of Partial Hand M-Fingers. A, Position of the ngers with the wrist in
Chapter 12: Harnessing and Controls for Upper Limb Body-Powered Prostheses
Figure 4
wrist exi on (A) and extension (B) that can b e used to actuate a body- powered, split-hand pros thesis. (Courtesy of David B. Rotter, CPO, Scheck and Siress, Chicago, IL.)
Photographs of a p atient with a left pa rtial hand amputati on demonstrating resid ual
Figure 5
split-hand prosthesis. (Courtesy of David B. Rotter, CPO, Scheck and Siress, Chicago, IL.)
Photograph of the Minnesota
Figure 6
ing of the hook in the neutral position. Positioning the hook with wrist exion (B), full pronation (C), and radial deviation and wrist extension (D).
(Courtesy of David B. Rotter, CPO, Scheck and Siress.)
transcarpal level or a traumatic partial
hand amputation (Figures 4 and 5).
Photographs of traditional gure -of-8 harnessing of a partial hand prosthesis, which allows multiple degrees of freedom. A, Full open-
harness can support carrying heavier loads by dispersing the pressure
options to position and then activate the
prosthesis in space.
through the broad surface area of the
Traditional Harnessing
Another option is the use of a traditional
figure-of-8 harness for a partial hand
amputee (Figure 6). The figure-of-8
harness. The harness also allows the
anatomic motions of wrist flexion and
extension with full pronation and supination, which allows the user many
Transradial Applications
History
Artifacts and drawings have documented historical attempts at producing
© 2016 American Academy of Orthopaedic Surgeons Atlas of Amputations and Limb Deciencies, Fourth Edition
161
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