It appears that today and in these days, nowadays and in our modern times, below elbow amputation is very rare and while no ergotherapist, physiotherapist, orthopedic surgeon, dermatologist or psychiatrist will see an arm amputee in practice in thirty years here, the "rare disease" community also (!) fails to acknowledge the fact that a realistic incidence estimate of below elbow amputation of around 1/50'000 entails the exact same consequences that other rare diseases and orphan drugs entail.
Yet there are miles to go before we sleep.
In the olden days, arms were removed more often, and knowhow was generated and documented by people that may not have had as much gadgetry and immediate networking opportunity as nowadays but who were just as clever, curious and differentiated as one would ever wish.
I now will type up some short summary points of a handbook published after World War I by Muirhead Little .
Prosthetic replacement can be just an option for one armed amputees, nothing else
There are two entirely different categories of arm amputees:
- single amputees
- double amputees
If one is to find solutions, these are entirely different for these two categories. As this is a single below elbow amputee issues blog, easy to understand that I am partial to the one handed solution category.
Those who have lost one hand or arm can very often do just as well with one sound hand as with two. To the labourer and to the handicraftsman whose work is bimanual, however, a prosthesis is necessary .
Principles to employ for prosthetic arms
The more simple the efforts to operate a prosthesis the more useful it will be. The design and details of manufacture, the type and fit of all parts, the quality of the engineering, those present the greatest difficulties for prosthetic arms . Conversely, the fit of the socket to the stump is not nearly as difficult to get right for prosthetic arms. - The reverse appears to be the case for prosthetic legs .
The socket of a prosthetic arm first and foremost should be very tight and accurate, close and precise . As arm stumps do not tend to expand or shrink too much over time, such a fit often is not impossible to achieve.
The most important factor in the estimation of the value of an arm stump is the character of the patient himself. Those who have pluck and perseverance, those that are so fortunate as to be endowed with the will to make good, will succeed in the use of almost any prosthesis - and the better the prosthesis, the better their work will be . There are others who are easily disheartened after a short trial or who will not try at all .
Many ingenious appliances have been invented, some of which are valuable for special purposes. The plain steel hook, however, is the most generally useful and can be put to a very great number of uses by persevering and energetic men . However, such simple arms are very generally useful for forearm stumps of sufficient length - but for above elbow stumps and short below elbow stumps, their usefulness is limited . Artificial hands (as opposed to hooks) serve to some extent (not completely) to mask the mutilation and occasionally, such an artificial hand can be useful .
Any terminal device - which is particularly important to mention for artificial hands as these seem to contribute most to overweight devices - must be built as light as ever possible . Since the terminal device is situated at the very end of the lever, every ounce of weight makes itself very distinctly felt . One problem of the ingenious CARNES arm was its heavy weight.
 Ernest MUIRHEAD LITTLE (1922) Artificial Limbs and Amputation Stumps - A Practical Handbook. London, UK: H. K. Lewis and Co LTD.