An above-elbow amputee has to decide, in consultation with a prosthetist, what kind of elbow joint to incorporate into an upper limb prosthesis. The appropriate elbow aids the amputee in manipulating the arm and hand to more readily carry out tasks.

Often a prosthesis will be a "hybrid design," meaning it combines different types of components - a common setup, for example, for an above-elbow amputee is an arm with an electric hand and a mechanical elbow.

The amputee has numerous elbow options to choose from:

• Coventional Elbows (Friction & Mechanical)
• Electric Elbows 
• Children's Elbows 

Conventional elbows are popular choices for amputees. They offer good function and are more lightweight than electric elbows. Weight is a very important consideration especially for above-elbow and even higher level amputations - the higher the level of amputation the more difficult it becomes to carry the weight of heavier components. The most commonly used conventional elbows include adjustable friction and/or mechanical (cable-operated) controls.

Elbows with adjustable friction allow the amputee to use the sound hand to raise or lower the elbow to the desired position. There are friction elbow options for adults and children.

Cable-operated mechanical elbows are operated by a cable and harness system. The arm is swung forward using body movement to raise the lower part of the arm and the elbow then locks the lower part of the arm into a bent elbow position. By using shoulder and back muscle movements, a cable can be pulled to unlock the elbow joint to lower it, raise it higher or leave it free-swinging.

Hosmer has a wide range of conventional elbows suitable for children and adults (from the E-50 series to the E-400 series). Some of the elbows are free-swinging and lock into varying positions; others have adjustable friction control and must be manually positioned by the amputee using the sound hand. Hosmer also has heavy duty elbow joints appropriate for use in certain occupations such as a farming, ranching or car mechanics. In addition, Hosmer has an Endoskeletal Elbow (foam covered prosthesis) that is lightweight and has eight locking positions that are operated with a push button. They also have a Manual Lock Elbow and Alternating Lock Elbow. Hosmer also has a Forearm Lift Assist that can be incorporated into the E-400 or E-200 elbows to allow the amputee to use less energy in operating these elbows.

RSL Steeper has Mechanical Elbows with Humeral Rotation Lock. They use a cable system with an alternating lock. The humeral rotation unit allows the lower part of the arm to be manually turned inwards or outwards and can be locked to facilitate using the arm for certain tasks.

Otto Bock has a wide range of elbow joints, too many to cover in this article. A modular elbow allows for a cosmetic foam covering. Several of their elbows have a passive lock that locks into 13 positions (at 8º increments) and numerous versions have an upper arm rotation joint. Another elbow set-up has a draw lock and locks into 18 locking positions (at 7.2º increments) with the upper arm rotation joint - it is suitable even for elbow disarticulation amputees. Another elbow has all of the features of the one above and, in addition, includes the Automatic Forearm Balance (AFB). Amputees sometimes find it difficult to make the exaggerated body movements required to get the lower part of the arm to raise up to lock into position. The AFB is a pulley-like mechanism placed in the forearm of the prosthesis that only requires a minimum of body momentum or force to activate - it raises the forearm of the prosthesis in a more fluid and natural way. It can be used with a mechanical elbow and electric hand combination, and is suitable for adults and children.

Electric elbows can be raised or lowered through a variety of controls such as myoelectrics, switches, touch pads, or force sensitive resistors.

The biggest issue for the amputee to consider with an electric elbow is that it adds extra weight to the limb making it heavier than a mechanical elbow. The amputee must weigh the benefits of the extra function over the extra weight, especially for those with high levels of amputation. Another issue to consider is the high cost of some of the items as funding may be a concern.

If an electric elbow is preferred, there are numerous prosthetic companies who make them.

Hosmer has an Endoskeletal Electric Elbow, and the NY Electric Elbow series which can be operated with myoelectric or switch controls and comes in styles for an exoskeletal (hard outer shell) or endoskeletal (foam cover) prosthesis.

Liberating Technologies' Boston Elbow can lift more than nine lbs while in motion and 50 lbs when locked. It has a free-swing range of 45º. It has a clutch that automatically locks the elbow whenever it stops moving, and unlocks it as soon as power is applied to its motor.

Motion Control has the Utah Artificial Arm - the elbow locks automatically whenever the elbow is motionless for about one second, and it is unlocked by triggering a button or switch, or by using a muscle contraction. It can then hold up to 50 lbs when locked. The elbow is otherwise free-swinging.

VASI (Variety Ability Systems Inc.) manufactures the smallest electric elbows suitable for children's prostheses. The VASI elbow series includes the world's smallest electric elbow, the VV 3-8 for children three to eight years old; and the VV 8-12 for children eight to 12 years old.

These elbows are powered by 6-volt rechargeable nickel-cadmium batteries and can be controlled by myoelectric systems or by switches. They also allow for passive 90º rotation at the upper arm (humerus) which enables the amputee to turn the arm in and out to position it for certain tasks.

VASI has a Child's Single-Axis Friction Elbow Joint that is useful for children and young adults with long stumps who cannot be fitted with electric or conventional elbows.

Liberating Technologies also has two friction elbows for children, the RSL Steeper Friction Elbow comes in an infant's size and a child's size - both can be used with passive or myoelectric hands. They can also be used as a shoulder joint.

Hosmer has cable-operated elbows in sizes to suit children.

Otto Bock has an elbow set-up for children with a passive elbow lock that locks in 10 positions (at 8º increments) and an upper arm rotation joint. Its Automatic Forearm Balance can be used in some children's fittings.