Shoulder disarticulation prosthesis
A comprehensive upper limb prosthesis configured from the shoulder level, consisting of a torso socket, prosthetic shoulder joint, elbow, wrist and terminal device.
What is a shoulder disarticulation prosthesis?
A shoulder disarticulation prosthesis is a comprehensive prosthetic fitting configured from the shoulder joint, at one of the highest levels of the upper limb. This level covers two closely related forms of loss: in shoulder disarticulation, the arm is separated at the shoulder joint and the shoulder girdle is largely preserved; at the forequarter (interscapulothoracic) level, part of the shoulder blade and collarbone is also removed together with the arm.
Because all the joints of the arm (shoulder, elbow, wrist and hand) are lost at this level, the prosthesis re-creates the entire arm. The system usually consists of a socket that sits on the torso and shoulder girdle, with a prosthetic shoulder joint, prosthetic elbow joint, wrist and terminal device attached to it. As the level rises, the function the prosthesis has to take on increases, so compatible component selection, a custom-made socket and comprehensive rehabilitation are of great importance.
Levels of arm amputation
The level at which amputation takes place determines which natural joints are preserved and which components the prosthesis needs. The diagrams compare four different levels; they do not indicate dimensions.
Below-elbow (transradial)
The elbow joint is preserved; the hand and part of the forearm are absent. The prosthesis is planned with a socket adapted to the remaining forearm, a wrist unit and a prosthetic hand or hook.
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Above-elbow (transhumeral)
The amputation is at the level of the upper arm; the natural elbow, forearm and hand are absent. In addition to the upper arm socket, the prosthetic system includes a prosthetic elbow, a wrist unit and a hand or hook.
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Shoulder disarticulation
The arm is separated at the level of the shoulder joint; the upper arm, elbow, forearm and hand are absent. The prosthetic fitting is planned with a custom-made socket adapted to the shoulder region and components that will take on the functions of the arm.
Wrist amputation
In wrist disarticulation, the hand is separated at the wrist joint; the forearm and natural elbow are preserved. The prosthetic hand and connecting components are selected according to the length of the preserved forearm and the person's needs.
Structure of the system
In shoulder-level fittings, the prosthesis consists of a series of components connected to one another from the torso to the end of the limb. At the top is the socket that encloses the torso and shoulder girdle; this is followed in turn by the prosthetic shoulder joint, the prosthetic elbow joint, the wrist and the terminal device.
This integrated structure aims to support positioning the arm in space, elbow movement and grasping with the terminal device. Because the number of components and the movements to be controlled increase, planning and training are particularly decisive at this level.
- A custom-made socket that sits on the torso and shoulder girdle
- A prosthetic shoulder joint that enables positioning of the arm
- A prosthetic elbow joint that takes on the bending and straightening function
- A wrist unit and terminal device that enable grasping
Why is it a more extensive fitting?
The factors below explain why shoulder-level fittings require a staged and individual process. Results vary from person to person.
More function
Because all the joints of the arm are lost, positioning of the arm and grasping are taken on by the prosthetic components.
Multi-joint control
Managing the shoulder, elbow and terminal device requires coordination that takes time to learn.
Weight and suspension
Balanced suspension of a more extensive system on the torso is important for comfort and all-day usability.
Staged progress
Goals are set individually; progress is achieved step by step and with regular follow-up.
Control methods
At the shoulder level, control of multiple movements is planned. Which method is appropriate is determined by the specialist team according to muscle signals, the condition of the residual limb and shoulder girdle, and the person's goals.
Myoelectric (electronic) system
An electronic approach in which the aim is to control the prosthetic joints and terminal device with muscle signals.
Learn moreBody-powered (mechanical)
A durable approach in which movements of the shoulder girdle and torso are transmitted to the joint and terminal device via a cable system.
Targeted muscle reinnervation (TMR)
In high-level loss, a surgically supported approach that aims to provide access to more muscle signals by rerouting nerves.
Learn moreComprehensive rehabilitation and training in use
In shoulder-level fittings, rehabilitation is one of the most decisive factors in using the system efficiently. Coordinated management of multiple joints and the terminal device is acquired through planned and regular training.
The process usually begins with basic positioning and control exercises; skills aimed at daily tasks are then added gradually. Appropriate socket fit, balanced suspension and component selection are prerequisites for successful use and for reducing the rate of prosthesis abandonment.
The fitting process
Physician's Prescription / Medical Report
The process begins with a specialist physician's prescription/medical report.
Comprehensive Assessment
The condition of the residual limb and shoulder girdle, muscle signals and goals are assessed; the appropriate components are planned.
Measurement and Fitting Trial
A custom-made torso socket and system are fabricated; the fitting trial and suspension adjustments are carried out.
Rehabilitation
Step-by-step control and usage training is provided; coordination is developed gradually.
Follow-up and Adjustment
Check-ups are planned; fit, suspension and maintenance are reassessed over time.
Frequently asked questions
What is the difference between shoulder disarticulation and forequarter amputation?
In shoulder disarticulation, the arm is separated at the shoulder joint and the shoulder girdle is largely preserved. At the forequarter (interscapulothoracic) level, part of the shoulder blade and collarbone is also removed. In both cases, the function of the arm is re-created with a prosthesis.
Can daily functions be regained with a prosthesis at this level?
Certain functions can be supported with appropriate component selection and comprehensive rehabilitation. Individual results vary according to general health, muscle signals and participation in rehabilitation, and are determined through a physician's assessment.
Why does a shoulder-level prosthesis require more training?
Because coordinated management of the shoulder, elbow and terminal device is required, multiple movements have to be controlled together. This coordination is acquired gradually through structured training.
This content is for informational purposes; please consult your physician for diagnosis and treatment. Applications are carried out at our licensed center locations in line with a specialist physician's prescription/medical report.
