Comprehensive Accelerated Fitting ProcessAbove the Elbow Amputations
Prosthetic ChallengesMaintenanceLifelong Care

Why Doesn’t My Upper Limb Prosthesis Fit Right?

Amber Henson
by Amber Henson
Jun 11, 2024

We hear this question often from new patients who come in after they’ve been fit by another provider. It is NOT something we hear from our patients after they’ve been fit at an Arm Dynamics center. Why is that?

A big reason people have trouble getting a device that fits right and feels comfortable is that most prosthetists have minimal experience working with upper limb patients. In the United States, only 10% of all amputations and limb differences are upper limb.* That means almost all other prosthetic care providers spend most of their time fitting patients with lower limb prostheses. They might fit one or two upper limb patients during a year’s time — and many may not see an upper limb patient at all. But when someone has experienced upper limb amputation or has a congenital upper limb difference, they shouldn’t have to settle for prosthetic care that’s “okay” when what they need is a prosthetist who specializes in upper limb. Over the past 25 plus years, our Arm Dynamics clinicians have worked with thousands of patients, and each year, hundreds of patients visit our centers. We have many patient success stories that demonstrate our patients are happy with their fit.

“We have had patients come to us after being fit by a different provider,” notes Arm Dynamics prosthetist Mac Lang in Portland, OR. “In some ways that makes the fitting process easier because they know exactly what they don’t want. They know enough about how it feels to wear a prothesis to understand what it is about their device that isn’t working for them, and what could be changed to make it comfortable.”

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Our patient Isaiah (pictured above) had his hand amputated at the wrist after an accident at work at the age of 22. Isaiah did his research and knew that an Arm Dynamics center was where he wanted to head to learn more about his options. He came in for a complimentary consultation and discussed his goals: get back to work and get back to the gym. Isaiah has a clear memory of prosthetist Mac Lang telling him, “No problem.”

The problem Isaiah wound up running into was with his workers’ comp insurance. They were the ones paying for his prosthetic care and they wanted him to go to a different provider first. So he did, and he was fit with a myoelectric hand. Afterward, he found the overall prosthesis to be too big and very heavy. When he asked about working out at the gym with a prosthesis, he was told that his gym goals were unattainable. Isaiah wasn’t happy. “I think a lot of these other companies get away with mediocrity. People don’t know what’s possible, so when they get fit with a device, they just think, ‘Oh, well, this is the best that can be done.’ But that’s not true.”

Isaiah persevered. Again, he told workers’ comp he wanted to go to an Arm Dynamics center — and again they sent him somewhere else. Same result — a bulky socket that slid right off. Isaiah went back to workers’ comp, and they finally sent him to us. “My previous experiences weren’t good. The frames they fit me with were way more cumbersome, at least 40% bigger than what I have now. Now I have a good fit after coming to an Arm Dynamics center. They taught me how to use my hand and I have a working activity-specific prosthesis so I am thankfully back in the gym.” You can read more about Isaiah’s experience in our article Saving Money, Saving Time: Getting Prosthetic Care Right the First Time.

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Isaiah’s story is just one of many we’ve heard when people come to us after seeing a general prosthetist first. When Craig (pictured above) came to us for an evaluation, he was experiencing nearly constant pain and the feeling of pins and needles in his residual limb. His local prosthetist fit him with a device that was so heavy he could only wear it for a few minutes at a time. Once he came to us, we determined that a shorter prosthesis could work for him, and now Craig is getting back into hunting and fishing.

Our patient Emily has an above elbow amputation and also has arthritis in her sound hand. “My first socket, from my previous provider fell off all the time — it never fit. I put it in the closet for about two years and just did my best to get by.” Now, with her new socket, frame and single-motor myoelectric hand, she’s wearing her prosthesis an average of five or six hours a day. “It’s night and day for my balance.”

For bilateral upper limb amputees, there is no “getting by.” They must be able to wear their sockets daily and for longer periods of time just to navigate life. Our bilateral, transradial level patient, Jason (pictured below), was initially fit by a prosthetist who was located near his home in Kentucky. “Those sockets for my myoelectric hands hurt. Moving my arms to hold things, that hurt. They’d put the sensors in the wrong place, so it was nearly impossible for me to actually control them.” Jason’s original prosthetic care company had all the right tools but were limited on experience. “I really liked my prosthetist; he was a nice guy. But I had to move on — I needed to do what was best for me and my family.” For Jason, that meant traveling to see our prosthetist Rob Dodson in our Dallas, TX, center. Now, Jason is part of the Arm Dynamics family.

Jason and Family walking

Our prosthetists understand that having a functional upper limb prosthesis that fits well can make all aspects of life possible. Career goals, life goals, hobby goals — those ambitions go from a possibility to a reality. Our accelerated fitting process, while fast, is comprehensive. It starts with making a trial prosthesis, which allows our prosthetists, technicians and prosthetic assistants to see what is working and what needs improvement. Then while they work on the prosthesis that our patient will take home, our clinical therapy specialist works with each patient, strengthening their residual limb and teaching them how to use their device to reach their goals. This means we have a lot of tools in our centers, from shovels to cookware to weight bars to fishing rods! Once the definitive prosthesis — the take-home prosthesis — has been completed, we make sure that our patients are happy with the fit and make tweaks to optimize the fit and function. Even then, we’re not done with our patient, because we follow up with them after one-month, and again at three-months, six-months, and one-year.

Yes, you may need to travel for this kind of prosthetic care. Yes, you may need to appeal to your insurance provider for this kind of prosthetic care. But our patients tell us that it’s worth the extra effort. An upper limb difference is the kind of difference that requires a specialist, and we are upper limb specialists.

If you or someone you know could use competent, experienced upper limb prosthetic care, please contact us. If you would like to leave a comment regarding this article, please do so below. We hope you have found this article helpful.

*Source for statistic above about percentage of upper limb amputations: page 35 of InMotion Magazine, Volume 21, Issue 5.

 

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