Above the Elbow vs. Below the Elbow: Your Prosthetic Options

The terms transradial and transhumeral describe where the limb difference occurs, and that location changes everything.

A below-elbow limb difference (the acquired form is called transradial amputation) means the limb is absent or ends between the wrist and the elbow, whether from birth or through acquired limb loss. The elbow joint is intact. The muscles in the forearm that would normally control the wrist and hand are partially or fully present. That remaining musculature is what myoelectric devices use to generate control signals.

An above-elbow limb difference (the acquired form is called transhumeral amputation) means the limb is absent or ends between the shoulder and the elbow. The elbow joint is absent. Control signals must come from higher up in the arm, typically the biceps and triceps. A prosthetic device at this level needs to replace both elbow and hand function, which significantly increases the complexity of both the hardware and the control system.

Both levels are common across acquired and congenital presentations. The prosthetic path for each is distinct but well-established.

People with below-elbow limb differences retain the elbow joint, and Open Bionics fits below-elbow patients directly through its US clinics.

Retaining the elbow means the prosthetic system does not need to replicate elbow function, only the hand and wrist. Open Bionics’ socket is currently designed for below-elbow limb differences, where the complexity of an elbow joint is not a factor. The fully wireless MyoPods can be placed anywhere on the residual limb to detect muscle signals, which are then translated into grip patterns by the Hero PRO or Hero RGD. Most people learn to use this control system quickly, and with training it becomes intuitive.

The practical result is a device capable of handling real-world demands across work, daily life, and activity. Lucy, a Hero Arm user who works in a warehouse, described what that means in her day-to-day.

Daniel, who works as a technician, found the same was true in his field.

The effect goes beyond function. Jio, another Hero Arm user, described a shift in how he experienced himself outside of wearing the device.

We operate specialist upper limb clinics across the United States and fit people with below-elbow limb differences with the Hero Arm, Hero PRO, and Hero RGD. Each device is custom-fabricated to the individual’s residual limb, and all clinical appointments are included.

People with above-elbow limb differences face greater complexity, but their options have expanded significantly.

People with above-elbow limb differences face greater system complexity because the prosthesis must replace both elbow and hand function. Our Hero Flex socket is currently designed for below-elbow limb differences, as it does not include an elbow joint. The Hero PRO’s fully wireless MyoPods can be placed anywhere on the body to detect muscle signals, which is precisely what makes it well-suited as a terminal device in above-elbow systems built by partner prosthetists.

Traditional myoelectric systems for above-elbow users relied on sequential control: the user switches between elbow mode and hand mode using a dual muscle contraction. Every movement requires deliberate thought. More recent advances, including pattern recognition systems and targeted muscle reinnervation (TMR), have improved this significantly by creating additional control sites and allowing more natural, simultaneous movement.

Mike, a military veteran and Hero RGD user, has worn bionic arms for 30 years. His take on where the technology stands now is direct.

Eric made the trip from Michigan to Chicago with his father-in-law, who had lost his arm in a machine press over 50 years earlier and had never considered a bionic option. Eric described what that appointment meant for his family.

People with above-elbow limb differences can request the Hero PRO as a terminal device through an Open Bionics partner clinic.

Open Bionics fits people with below-elbow limb differences directly through its specialist US clinics. Above-elbow presentations require a prosthetist who can fit the full system including the elbow component, and Open Bionics supports those cases through its partner clinic network.

A recent case involving AlliedOP and Open Bionics illustrates how that works in practice. Angelo Russello, a senior prosthetist at AlliedOP, was referred an adult with an above-elbow limb difference who had researched the Hero PRO online and wanted to explore it as a terminal device option. She had reduced function in her sound arm, which made precise grip and daily task function a priority. Clinical evaluation showed limited viable control sites on her upper arm, which ruled out a fully powered myoelectric elbow.

A hybrid configuration offered the practical solution. The fully wireless design of the Hero PRO allowed both a body-powered hook and a myoelectric hand to be used through a single socket, connected via the standard quick-disconnect wrist adapter. The patient can switch terminal devices depending on the task.

Angelo worked closely with Daniel Green, a clinician at the Open Bionics New York clinic, to review compatibility and system setup throughout the process.

The single-socket hybrid approach also addressed practical constraints around insurance coverage and fabrication, reducing the need for additional sockets while supporting long-term adoption.

Regardless of the level, the most important factor in prosthetic success is the clinical team behind the device.

The hardware matters. The socket fit matters. Comfort matters more than almost anything else, because a device that does not feel right does not get worn, and a device that does not get worn cannot help anyone.

Beverley had worn prosthetic arms for over 40 years before switching to the Hero Arm. The difference she described was not just functional.

Kristin, a quad amputee, switches between her Hero PRO and a Hero Arm depending on the task. Her bionic arms helped her walk again.

What both levels share is the goal of getting the most out of life. Your clinical team at Open Bionics and our partner clinics will work with each person to fit the right device to your specific goals.

Knowing your level is helpful, but a free consultation is where you’ll learn your options.

Whether your limb difference is below or above the elbow, a conversation with a specialist is where you move from general information to a plan that fits your specific anatomy, goals, and life.

We operate specialist upper limb clinics across the United States. People with below-elbow limb differences can book a free consultation directly. Those with above-elbow limb differences can speak with their prosthetist about accessing the Hero PRO as a terminal device, or register on our website to stay updated on bionic hands for above-elbow users.