Advancements in Upper-Extremity Prosthetics

There have been many additional components offered for children with upper limb involvement; however, one of the most exciting advancements comes in the form of a new application to nerve transfers.

Following amputation, the remaining peripheral nerves (ie, median and distal radial nerves) are grafted to denervated muscle sites in order to create additional, distinct myoelectric sites for the user that are physio­logically appropriate, as illustrated in Figure 13.14. For example, on the transhumeral limb, the medial head of the biceps and the lateral head of the triceps are dennervated and reinnervated by the median and dis­tal radial nerves, respectively. When the reinnervation is complete (after approximately four to six months) these two additional myoelectric sites are available for physiological control of closing and opening of a myo­electric terminal device. The prosthetic socket then incorporates four independent myoelectric sites for con­trol of elbow flexion and extension, via native lateral biceps and medial triceps, and control of the terminal device by the aforementioned reinnervated muscles. Increased efficiency and ease of use have been positive outcomes from this surgical intervention.