Upper and lower limb
prosthesis
Dr. Hassan El Sharkawy
Definition
Amputation:
the surgical removal of a part of the body, a
limb or part of a limb
Amputation: Etiology
 Trauma
 Burns
 Peripheral
Vascular Disease
 Malignant Tumors
 Neurologic Conditions
 Infections
 Congenital Deformities
Levels of amputation
What is prosthesis?
A
device used to replace an absent body
part whether due to trauma, disease or
congenitally absent ones
Types of Upper Limb Prosthesis?
 Prosthesis
of the upper limb may be
cosmetic, functional or combination of
both.
WHAT IS THE FUNCTIONS OF
THE UPPER LIMBS?
 The
whole upper limbs function to place
hand in adequate position to fulfill a
particular task.
 Hand tasks:
1- Manipulative tasks.
2- express feeling.
3- Explore environment.
 No prosthesis can replace all function
satisfactory. Selection is based in specific
requirement of the amputee.
Cosmetic Upper Limb Prosthesis


This is the simplest and lightest type
available.
For transradial (forearm = below elbow) it
consists of:
1- Foam filled glove with
2- Wired fingers
3- Fitted to a self
suspending socket.
Advantage of this prosthesis
 It
provides best cosmetic replacement but
with minimal functional benefit e.g.:
Holding objects steady or carrying things
over forearm.
 N.B: Individually sculpted silicon hands
are available which are excellent
cosmetically but expensive and not strong
enough for any practical daily tasks.
Functional U.L. Prostheses
 These
are upper limb prostheses that
includes a control mechanism of the hand
component (terminal device), and different
joint replacement units (either for wrist or
elbow joints).
 There are two types of control systems
namely:
 Body- powered control system
 Electric control system
A) Body powered:
 This prosthesis is the
simplest functional
prostheses.
 Body movement is
harnessed to control the
terminal device (and
elbow). A set of
appendages harness the
body movement.
Examples

(1) biscapular protraction, (2)
shoulder flexion (and elbow
extension = in cases of transradial
amputation) are used to control
terminal device.
 Shoulder depression, extension,
internal rotation, & abduction
operate the elbow lock in trans
humeral amputation.
 This type of prosthesis is a working
tool & it is functional rather than
attempting to be cosmetic
Body Powered functional U.L. Prosthesis:
Terminal device, Wrist unit, operating cord,
suspension loop
Electric control systems:
A battery – operated
motor moves the hand
and/or gripper, wrist or
elbow by either:
 Myo-electric control.
 Servo control.
 Switch control.
Rechargeable.
1- Myo-electric control
 Electrodes
pick up microvolts of electricity
produced by contractions in the muscles of
the residual limb.
 Signals
are amplified and thereafter they
activate the motor.
 In
operating hand there may be 2
electrodes; one on extensor muscles and
one of flexor muscles groups for opening
& closing the hand respectively.
 Alternatively
a single site
placement for voluntary
opening & automatic
closing can be used.
 Wrist movement can be
controlled myo-electrically
using 2 site system.
 An electric elbow lock can
be activated be a single
site placement
2) Servo Mechanisms

The same movements used to
control body powered
prosthesis, can operate an
electric hand but with less
shoulder girdle movement.
Where mechanical energy is
transmitted into electric energy
to operate the device motor (s).
3) Switch control

Using harness or touch pads to
control electric devices in
different ways.
Terminal devices


Used to replace the task of the
hand,
It may be cosmetic or functional /
passive or active.
*** The most commonly used active
functional device is the split hook.
 It consists of once static – one
movable new.
 Grip is achieved by elasticated
bands holding the two jaws
together, and can be increased by
increasing number of bands.
 The device is activated by harness
attached to the lever of the moving
jaw as residual limb moves,
harness pulls the jaw open,
providing good proprioceptive feed
back.

If cosmoses are
important, a cosmetic
hand can be provided.
 If patient seeks
combination between
cosmoses and function,
same device as above is
used but with mechanical
hand  same shape as
the human hand and
body power pulling the
thumb and fingers apart.

Mechanical hands have some disadvantages
that include:
1- It is harder to operate than the split hook.
2- It has a poorer grip.
3- Bulky & making precision difficult.
Despite this it is helpful if an amputee not
demands high level of manipulative skill from
the prosthesis.
 Terminal
devices with special tasks:
Active: pliers – tweezers- Pen holders
(using operating cord).
Passive: hammer, fishing red holder tool
holder.
Prosthetic Joints
 Wrist
unit:
A cylindrical wrist unit either hand or
electrically operated to provide 360°
rotation, allow positioning of the terminal
device in adequate supination/ pronation
range for the required task. Usually wrist
units have a disconnect facility allow
change of terminal device.
 Elbow
joint:
Several forms of prosthetic elbow joints
are in use. Hand operated joints are
commonly used with cosmetic prosthesis.
In addition, body powered elbow joints,
used with body powered prostheses, are
utilized. They are operated using operating
and elbow lock cords. Operating cord
operates the terminal device when the
elbow is locked, while with elbow unlocked
it operates the elbow joint.
Suspension
 For
hand amputation and wrist disarticulation
self suspension is used that depends on
hanging the socket to bony prominences,
namely radial and ulnar styloid processes.
 For transradial amputation when using a supra
condylar socket, self suspension is applied
using medial and lateral humeral epicondyles
for hanging the prosthesis.
N.B.:
 In case of transradial amputation cup
socket is used when amputee need carry
heavy objects, with very short residual
limb, or bilateral amputation.
Supracondylar socket is used with
cosmetic and passive terminal devices.
 In
wrist disarticulation supination
/pronation is controlled by wrist unit or by
split socket with one section at the wrist
and the other at the distal part of the arm,
sparing the forearm to perform movement.
Lower Limb Prosthesis
Types of lower limbs
prostheses :
 Types of L.L. prostheses
depend on different stages
after amputation. There
are three types:
- Immediate postoperative prosthesis.
- Temporary prosthesis
- Definitive prosthesis.
Levels of lower limb amputation
Types of Prosthesis
PROSTHETICS
LOWER EXTREMITY
BELOW KNEE
KNEE
DISARTICULATION
ABOVE KNEE
HIP
DISARTICULATION
The basic components of a lower extremity prosthesis include:
the socket, a sock or gel liner, a suspension system, a knee joint (articulating joint),
the shank (a pylon), and a foot (terminal device)
.
I- Immediate post- operative
prosthesis
 Used
for young patients, usually after a
traumatic injury.
- Consists of rigid dressing pylon, and foot.
- Pylon is usually made of aluminum, steel
or plastic.
- It helps patient to gain psychological
support, early walking (with assistive device
5-12 days post operative) leads to less
hospital stay, and reduce phantom pain.
 Disadvantages
are the possibility of
impaired healing & falls due to early
ambulation.
 Contraindication:




History of slow wounds healing.
Extreme obesity.
Excessive preoperative edema.
Lack of 45 days preoperative
ambulation.
II – Temporary prostheses

It is usually used for 3 to 6 month after amputation.
 It helps early weight bearing, and reduces edema in the
residual limb stamp.
 The most common type of temporary prosthesis is
adjustable prosthesis. It consists of a socket, pylon, foot.
It can be modified so that the foot in moved in medial,
lateral, anterior, posterior inversion, eversion direction.
These adjustments help to correct gait deviations,
increase energy efficiency, and make walking more
efficient and cosmetic. Therefore it is used in early
stages of gait training.
 Temporary prosthesis can be converted to definitive or
final prosthesis with cosmetic modifications.
III- Definitive prosthesis
 It
is used when limb volume becomes
stable.
 It can be applied 3-9 months
postoperative.
 Life span 3-5 years.
 Changes are needed when there is
residual limb atrophy, weight gain or loss.,
and excessive wear after prosthesis.
Prosthetic foot
 It
should be:
1- Providing stable base of support.
2- Shock absorption.
3- Joint & muscles stimulation.
4- Cosmetic appearance.
Types
Conventional
Dynamic response
I) Conventional
a) Articulated
Single axis: Have a single
Metal axis that allows plantar (15
degree) and dorsiflexion ( 5-7
degree). Internal keel surrounded
by foam-rubber outer lining.
Loaded with dorsiflexion bumper
that replaces eccentric
contraction of plantar flexors, and
plantarflexion bumper that
replaces eccentric contraction of
dorsiflexion. It allows level- floor
ambulation but does not allow for
walking on a steep incline.
Multiple- axis foot
 The multiple axis foot has
two joints, a rubber rocker
block that allows
dorsiflexion and
plantarflexion and a
transverse ankle joint that
allows rotation, eversion
and inversion. It contains
a wood keel and outer
cover of foam rubber. It
allows walking on level
ground and inclines
b) Non articulated
1- Solid Ankle Cashion
Heel (SACH)
Consists of wood keel that
extends forwards to the toe
break and is surrounded by
molded foam. The SACH
Compressible rubber heel
simulates plantar flexion. At
loading response the heel
wedge comprises to
simulate plantar flexion.
2- Stationary Attachment
Flexible Endoskeletal
foot (SAFE)
The SAFE foot keel, is
composed of rigid
polyurethane plate at an
angle 45 in the sagittal plane
to provide eversion and
inversion. To elastic bands
extend on the plantar
surface that courses the keel
to dorsiflex from mid- to
terminal stance. At pre swing
the keel releases.
II) Dynamic Response
1- Articulated
College Park True Step
 It has three axes one vertical and
two transverse axes. These axes
allow mobility in the three planes
of motion. Two bumpers, dorsiand plantar flexion bumpers are
included. In front there are two
split toes of carbon fibers.
 College Park ,sngised
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2- Non- Articulated
A) SHORT KEEL
1- Stored Energy foot
(STEN)
The keel is subdivided into
compressible and non
compressible segments, a
structure that allows energy
storage from loading
response to mid swing and
release it at push off.
2- Carbon Copy II
Consists of two carbon
fiber deflection plates
that return energy
during walking and
running. It has a
strong keel covered
by polyurethanefoam.
B- LONG KEEL
1- Flex foot:
Two elastic carbon fibers
attached to a horizontal
carbon foot plate. Carbon
fibers extend to include the
pylon.
2- Springlite foot:
Similar to flex foot, but
consists of one elastic
carbon fibers and one
fiber glass filaments
surrounded by a soft
cover. It is 30% less
expensive than flex foot.
1- Flex foot:
2- Springlite foot:
Sockets
Sockets for below knee
amputation is either Patellar
tendon bearing or total surface
Bearing sockets.

Total surface bearing
Complete weight bearing
evenly distributing pressure
on the contact surface
Suspension
Types
1- Supra condylar
(medial
wedge).
2- Supra
condylarsupra patellar
system.
3- Supra condylar
cuff.
4- Thigh corset.
5- Waist belt.
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