Upper limb prostheses: a narrative review of hand, wrist, and elbow devices

Upper limb amputation is among the most functionally disabling conditions, affecting an estimated 1.6 million people in the United States, with prevalence projected to double by 2050. Despite decades of technological progress, device abandonment rates remain persistently high, up to 45% for body-powered and 35% for myoelectric prostheses in the paediatric population, due to inadequate functionality, poor sensory feedback, discomfort, and social stigma.

This narrative review aims to provide a structured and up-to-date synthesis of upper limb prosthetic technologies, with a focus on hand, wrist, and elbow devices, analysing their structural characteristics, control mechanisms, clinical evidence on functional outcomes, and user satisfaction.

A structured literature search was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library, combining terms related to upper limb amputation and prosthetic devices. A primary corpus of peer-reviewed articles was selected to cover the full spectrum of upper limb prosthetics, from foundational biomechanics to advanced bionic and neural interface systems; a narrative approach was adopted to accommodate the heterogeneity of available study designs.

Across all device categories, no single prosthetic solution proved universally superior. Each category presents distinct functional, biomechanical, and psychosocial trade-offs, with prescription choices driven by amputation level, residual musculature, user priorities, and activity demands. Two limitations recur across every category. The first is the instability of surface EMG signals, which constrains reliable myoelectric control; the second is the absence of effective sensory feedback, which raises cognitive load and contributes to abandonment. Bridging the gap between laboratory performance and real-world usability, through more robust control algorithms, meaningful sensory restoration, and a shift toward user-centred, outcomes-driven development, remains the central challenge for the future of upper limb prosthetics.