Upper limb prostheses: a narrative review of hand, wrist, and elbow devices.
Alessio Fricano, Mattia Giuseppe Viva, Mario Vetrano and 9 others
No type of upper limb prosthesis outperforms another on standard functional tests, and the main reasons people stop wearing them are comfort, control, and function — not the lack of advanced features.
Choose based on the individual's daily tasks, not the device's spec sheet.
Key findings
1No category of upper limb prosthesis (passive, body-powered, single- or multi-grip myoelectric, 3D-printed) demonstrated across-the-board superiority, and current evidence is insufficient to conclude that any system offers a significant overall advantage over another.
2Multi-articulating myoelectric hands showed no statistically significant difference in SHAP or Box and Block Test scores compared to single-grip hands in transradial amputees, but over follow-up of six months or more, users reported improved satisfaction, perceived ease of activities, and quality of life.
3Restoring even limited wrist mobility, whether through passive, body-controlled, or motorised units, reduces compensatory trunk and shoulder movements and helps prevent secondary musculoskeletal overload.
Still to come
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a narrative review, not a systematic review: no formal risk-of-bias assessment was performed and no quantitative synthesis was undertaken, so the findings are a qualitative overview rather than a weighted comparison. The underlying evidence base is predominantly uncontrolled cross-sectional studies and small case series, frequently with fewer than 30 participants; randomised controlled trials are rare and almost exclusively in transradial amputees. Outcome measures are heterogeneous across studies (SHAP, BBT, Jebsen-Taylor, DASH, ACMC) and the minimal clinically important difference for these instruments has not been established for prosthesis users, making cross-study comparison unreliable. Most studies enrolled predominantly male participants, limiting generalisability to women and children. The review is restricted to English-language sources, which may under-represent work published in other languages. There is a substantial gap between controlled laboratory performance and real-world prosthetic use, and most studies emphasise short-term performance while under-reporting long-term adaptation, fatigue, and sustained device use. Article selection was guided by topical relevance, which may introduce selection bias.
Declared interests
The work was funded by the Italian Fund for Applied Sciences (FISA), a government research fund under the Ministry of Universities and Research, under a grant titled 'BIOMIPROHAP – Design, development and prototyping of an intuitively controlled biomimetic prosthetic arm equipped with haptic feedback and dedicated mobile software.' The funder is therefore also developing a prosthetic arm with haptic feedback, which is a potential conflict of interest given the review's discussion of sensory feedback as an unresolved challenge.
The easy way to misread this
Do not read the improved satisfaction and quality-of-life scores for multi-grip myoelectric hands as evidence that they are functionally better than single-grip hands — the review reports no statistically significant difference in SHAP or Box and Block Test scores between the two, and the satisfaction gains were observed only at six months or longer follow-up. A patient who needs a reliable, quick grip for a specific task may do better with a simpler device.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →