From “MEC '02 The Next Generation,” Proceedings of the 2002 MyoElectric Controls/Powered Prosthetics Symposium

Fredericton, New Brunswick, Canada: August 21–23, 2002. Copyright University of New Brunswick.

ADVANCEMENT OF UPPER EXTREMITY PROSTHETIC INTERFACE AND FRAME

DESIGN
Randall D. Alley, [Link]., C.P.
Hanger Prosthetics and Orthotics, Inc.
ABSTRACT
Although traditional upper extremity prosthetic interface and frame (collectively referred to here as
“interface”) designs have enabled many individuals to integrate prostheses into their rehabilitation
plan, the biomechanical attributes and other parameters of these designs have not been significantly
reviewed and improved upon until recently. In the last decade, a multitude of design innovations
have been incorporated, which have resulted in wearers reporting superior comfort, suspension,
stability, and range of motion, among other advantages. In most cases, when paired with a variety of
control systems, the new designs appear to be inherently more efficient in terms of force transmission
and motion capture, and more functionally consistent than traditional types of “sockets”. It is the
intention of this paper to highlight these novel design elements, as well as to discuss the
biomechanical principles involved, to enable prosthetic users and other individuals to better
understand these advanced interfaces.

INTERFACE DESIGN CRITERIA

The initial step in the improvement of an interface design is to first gain an understanding not only of
the underlying functional intent of its constituent structures, but the resultant effect of these structures
upon the critical elements responsible for successful prosthetic utilization.
The interface designs for three levels or degrees of absence will be discussed. These are the
radioulnar (transradial), humeral (transhumeral) and the glenohumeral disarticulation and
interscapulothoracic (shoulder disartic and forequarter, respectively) levels, the latter two
incorporating essentially the same design, albeit with minor changes to auxiliary suspension.
A brief comparison and contrast of both the physical and biomechanical properties of the traditional
interface model with its more contemporary associate will be given.
RADIOULNAR
Traditional self-suspending interface designs at the radioulnar level typically focus on three
distinct areas: 1) the supracondylar component; 2) the cubital component; and 3) the olecranonal
component. The soft tissue and skeletal anatomy distal to these
regions are generally enclosed with a simple circumferential
shape for volume containment. The ACC interface, in addition to
these elements, adds a relief and modification to the antecubital
region.
The Muenster design focuses on increasing anterior-posterior
(AP) compression in the cubital fold. The Northwestern design
focuses on increasing mediolateral (ML) compression proximal to
the epicondyles. The Anatomically Contoured and Controlled
(ACC) interface increases AP and ML compression but focuses
them in different areas. In addition to the antecubital region
described above, consideration is also given in the ACC interface Northwestern style
to the distal humerus and the proximal portion of the extensor interface
carpi ulnaris.
Comfort
The supracondylar component as addressed by the Northwestern design results in added
suspension throughout the full range of motion, but also compresses the sensitive area over both the
medial and lateral intermuscular septum, as well as the ulnar nerve and the medial antebrachial
cutaneous nerve, hence negatively affecting comfort. The Muenster design utilizes AP compression

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UNB and the Institute of Biomedical Engineering, through a partnership with Duke University and the Open Prosthetics Project.
From “MEC '02 The Next Generation,” Proceedings of the 2002 MyoElectric Controls/Powered Prosthetics Symposium
Fredericton, New Brunswick, Canada: August 21–23, 2002. Copyright University of New Brunswick.

primarily, but inherent instability can cause slight compression discomfort at the sensitive regions
described above in dynamic situations. In both designs, a lowered anterior brim minimizes the
effective lifting area of the forearm, and hence may increase lifting discomfort. The ACCI reduces
compression in sensitive areas while concurrently increasing compression posteroproximal to the
cubital fossa, and on either side of the antecubital relief, maintaining comfort while increasing
suspension throughout the range of motion. In both the Muenster and Northwestern designs, the
shape of the olecranonal modification often creates shear stress and compression problems as the
olecranon begins to displace toward the posteroproximal brim under flexion. The ACC interface
modifies the shape of the olecranonal relief to minimize or eliminate olecranon contact during
ranging as well as donning and removal.
Cosmesis
Both the Muenster and Northwestern designs reduce the proximal extent of the anterior brim,
and hence create a buildup of redundant tissue in the antecubital
region with prolonged use. The ACC interface’s antecubital region
prevents significant redundant build-up and its greater ML
compression tends to more readily conceal its more extensive
medial and lateral stabilizers.
Stability
In the Muenster and Northwestern designs, rotational
stability is minimally provided due to the general absence of medial
and lateral stabilizers. AP stability is often reduced during ranging
and is often lost at full flexion as the olecranon displaces
Redundant antecubital posteroproximally.
tissue caused by reduced In the ACC interface, the medial and lateral stabilizers significantly
anterior trim line improve rotational stability. In addition, ancillary rotational
resistance is provided by the modification of the antecubital area
and displacement of the olecranon throughout the flexion range is minimized by the vertical segment
of the interface proximal to the olecranon.
Suspension
Difficulties in achieving adequate suspension with the traditional designs arise in terms of either the
discomfort of applied compression in sensitive areas, or the lack of adequate compression in non-
sensitive areas. Additionally, the inclined olecranonal relief typically permits translation of the
residual limb out of the interface with the arm held over the head and the elbow joint is fully flexed.
The ACCI focuses on maximizing compression in areas deemed suspensory and minimally sensitive.
The olecranonal modification inhibits displacement of the olecranon posteroproximally.
Range of motion
Both the Muenster and Northwestern interfaces address
elbow flexion requirements by lowering (reducing the proximal
extent of) the anterior brim. This increases the build-up of
redundant tissue just proximal to the brim, which in itself is a
primary inhibitor of full flexion. The ACC interface extends
deeply into the cubital fold, while allowing a relief for the
biceps tendon as well as the antecubital tissue to expand into
during flexion. In addition, by significantly reducing the AP
dimension, flexion is increased.
ACC interface in
diagnostic phase

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UNB and the Institute of Biomedical Engineering, through a partnership with Duke University and the Open Prosthetics Project.
From “MEC '02 The Next Generation,” Proceedings of the 2002 MyoElectric Controls/Powered Prosthetics Symposium
Fredericton, New Brunswick, Canada: August 21–23, 2002. Copyright University of New Brunswick.

HUMERAL
The more traditional style focuses on basic volume containment along the humeral shaft and
vertical loading over the shoulder complex via the proximal portion of the socket.
Tom Andrew C.P.’s Dynamic Socket applies significant ML
compression along the length of the humerus while lowering the
lateral brim of the interface to a point between the axilla level and the
acromion. In addition, anterior and posterior stabilizers are utilized. A
derivative of the Dynamic Socket provides minimal ML compression
distally while maximizing it proximally, and concentrates AP
compression into a smaller area than can be found in the Andrews
design.
Comfort
The most common complaint is this design’s over-the-
Traditional humeral shoulder style suspension, in which the socket rests on the superior
interface surface of the humeral complex, and discomfort caused by this
interface’s inherent instability. Both the Dynamic Socket and its
hybrid cousin eliminate the interface contact on the proximal surface of the shoulder complex
resulting in greater comfort during abduction and with increased heat dissipation.
Cosmesis
Inherent instability and proximal interface coverage reduce cosmesis in the traditional
designs when the arm abducts or the ipsilateral scapula is elevated. Inherent stability in dynamic
situations and reduced trim lines improve cosmesis in newer interface designs.
Stability
The newer styles utilize anterior and posterior stabilizers as
well as ML compression, unlike traditional designs, to limit rotation
in both the axial and sagittal planes.
Suspension
As previously stated, traditional humeral interfaces rest on the
shoulder complex and occasionally on the trapezius in order to reduce
vertical displacement under load. The newer designs utilize a
shoulder saddle in most cases in order to achieve primary suspension.
In addition, a secondary suspensory component is provided by AP
compression anteriorly at the proximal overlap of the sternocostal and
clavicular heads of the Pectoralis major, medial to the delto-pectoral Humeral interface with
groove, and posteriorly at the level of the Infraspinatus. anterior stabilizer
Range of motion shown
In the traditional interface, range of motion is significant;
however, stability at the extremes is precarious. The Dynamic Socket and its derivative simply
reduce the medial projection of their anterior and posterior stabilizers to optimize the functional
envelope while retaining a significant degree of stability in all planes and at the extremes of available
glenohumeral motion.

GLENOHUMERAL DISARTICULATION AND INTERSCAPULOTHORACIC

A thoracic socket design that encloses and rests on the shoulder girdle is still the most
common interface style used today. Also referred to as “basket-type”, “bucket” or “encapsulatory”,

Distributed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License by
UNB and the Institute of Biomedical Engineering, through a partnership with Duke University and the Open Prosthetics Project.
From “MEC '02 The Next Generation,” Proceedings of the 2002 MyoElectric Controls/Powered Prosthetics Symposium
Fredericton, New Brunswick, Canada: August 21–23, 2002. Copyright University of New Brunswick.

this design has been used for decades. Newer interface designs rely on a frame-style approach, where
only enough proximal, distal and medial projection is utilized to achieve adequate stability.
Comfort
Poor heat dissipation and discomfort from instability are the most obvious and negative
aspect of traditional thoracic interfaces. Frame style interfaces such as the XFrame cover minimal
tissue, and are significantly more stable. Similar to the humeral interfaces, the XFrame utilizes a
discontinuous design which eliminates interface loading over the shoulder. The XFrame utilizes a
large projection of thermoplastic distal to the laminated border than is currently used in other designs
that greatly increases distal weight bearing comfort.
Cosmesis
Encapsulatory interfaces by nature are fairly cosmetic in the static anatomical position, yet become
readily observable in the dynamic phase, where even subtle body motion typically results in frame
displacements of large magnitude away from the body. The discontinuous feature of the XFrame
inherently prevents vertical displacement above the shoulder during these movements.
Stability
Traditional interface stability is nebulous due to its significant coverage of a dynamically
changing thorax and shoulder complex. Actions and reactions that
occur within the frame secondary to gross body movement tend to
leverage the socket off the body in a multitude of locations. This
occurs because of the varying shape of the cross-sectional area
defined by shifting contact points between the anatomy and the
socket. In the newer frame-style interfaces, full volume containment
is neither achieved nor desired, and as such stability is increased
during gross body movement.
The XFrame is inherently more stable than other interface and
frame designs in large part due to its geometry. Contact points
provide rotational resistance in all planes, while the absence of a
rigid transitional or suspending member over the trapezius prevents
Medial view of XFrame leveraging of the system off the body in response to gross body
with neoprene electrode movements. Additionally, both superior and distal AP compression
membrane and shoulder aids in restricting erratic motion of the frame in response to applied
saddle suspension force.

Suspension
As mentioned previously, suspension in both encapsulatory and most frame-style designs is
primarily achieved via a rigid socket or frame member extended over the shoulder complex or the
trapezius. In the inherently unstable encapsulatory design, it tends to be its Achilles’ heel in regards
to comfort.
In addition to a soft shoulder saddle, three additional suspensory elements are utilized in the XFrame
when possible: 1) superior AP compression similar to that that utilized in the newer humeral
interfaces described previously; 2) distal “hydrostatic” suspension over soft tissues (this also is
utilized in some other frame-style interfaces); and 3) an additional scapulospinal element involving
compression of the supraspinatus and the distal portion of the middle fibers of the trapezius.
Range of motion
It is important to discern between total range of motion, prosthetic range of motion and
functional range of motion. A complete discussion of this is outside the scope of this paper.
Inherently unstable designs may have excellent total range but are too unstable at the extremes to
provide adequate function. The XFrame is stable at any and all ranges and therefore functional as
well. The XFrame is the culmination of a long line of high-level frame designs that have been

Distributed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License by
UNB and the Institute of Biomedical Engineering, through a partnership with Duke University and the Open Prosthetics Project.
From “MEC '02 The Next Generation,” Proceedings of the 2002 MyoElectric Controls/Powered Prosthetics Symposium
Fredericton, New Brunswick, Canada: August 21–23, 2002. Copyright University of New Brunswick.

utilized for individuals requiring the use of a prosthesis. It was developed as a direct response to
significant weaknesses inherent in encapsulatory and other interface and frame styles, hence it
borrowed from their basic design elements and from many of the individuals over the years whose
work has preceded it. In clinical observations, the XFrame provides greater comfort, cosmesis,
stability, and suspension while maintaining a smaller footprint and hence covering less surface area
than more traditional designs.

Distributed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License by
UNB and the Institute of Biomedical Engineering, through a partnership with Duke University and the Open Prosthetics Project.